New Doctor Registration New Doctor Registration Form — View/Print Please complete and submit this form to register with MobileCAT. "*" indicates required fields Step 1 of 3 33% DOCTOR'S INFORMATIONDoctor's Name* First Last Email* Specialty OFFICE INFORMATIONOffice Phone*Office Contact Name First Last Office Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Who is responsible for payments to MobileCAT?* Doctor's office Patient SCAN LOCATION -- Dental Offices Only MobileCAT only schedules and conducts scans at the office of the patient's dental provider and ONLY during the dental provider's authorized hours of operation. ABOUT THE SCAN FILESWe currently use the following software: SimPlant Nobel Procera coDiagnostix Other Name of other software used: We need software to view scans: Yes -- iCAT visions We need DICOM files to view scans: Yes -- DICOM files
