Q4 Recovery qualification

See If the Program May Fit Your Practice

Share a few practice-level details. We review every completed form by hand before recommending a next step.

Your name*

Practice name*

Email*

Phone*

Practice website*

Number of practice locations*

Practice management software*

Basic program requirements

Can your practice provide approved access if needed?*

Does your practice have open appointment capacity?*

About how many appointments are open?*

About how many existing patients could be reviewed?*

Choose a rough range only. Do not upload or list patient information.

Can your practice verify communication consent?*

Does your practice have someone who can approve the work?*

Preferred call time*

Anything else we should know?

Important: Do not include patient names, treatment information, appointment information, or health information. Do not send passwords or access codes.

Every completed form receives a manual review. This form does not make an automatic eligibility decision.