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*Account Type	Select... Clinician Lab
*Referring Lab:	Select... Alternative Dental Lab Apex Dental Lab of Eau Claire Apex Dental Lab of Madison Apex Dental Lab of Milwaukee Apex Tempe Castable Ceramics Champlain Dental Lab Granite City Dental Lab Other Perfect Impressions ProSmiles Dental Studio Quad City Dental Lab Robertson Dental Lab Summit Dental Lab ProSmiles Sioux Falls
Production Lab:	Select... ProSmiles Dental Lab Surgical Guides Lab
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*Country:	United States Canada
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*Question 1:	Select... What was your childhood nickname? In what city did you meet your spouse/significant other? What is the last name of your favorite childhood friend? What street did you live on in third grade? What is your oldest sibling's birthday month and year? (e.g., January 1900) What is the middle name of your oldest child? What is your oldest sibling's middle name? What school did you attend for sixth grade? What was your childhood phone number including area code? (e.g., 000-000-0000) What is your oldest cousin's first and last name? What was the name of your first stuffed animal? In what city or town did your mother and father meet? What was the last name of your fourth grade teacher? In what city does your nearest sibling live? What was your first job? When you were young, what did you want to be when you grew up? Who was your childhood hero? What was the make and model of your first car? What was the first concert you attended? Who is your favorite singer?
*Answer 1:
*Question 2:	Select... What was your childhood nickname? In what city did you meet your spouse/significant other? What is the last name of your favorite childhood friend? What street did you live on in third grade? What is your oldest sibling's birthday month and year? (e.g., January 1900) What is the middle name of your oldest child? What is your oldest sibling's middle name? What school did you attend for sixth grade? What was your childhood phone number including area code? (e.g., 000-000-0000) What is your oldest cousin's first and last name? What was the name of your first stuffed animal? In what city or town did your mother and father meet? What was the last name of your fourth grade teacher? In what city does your nearest sibling live? What was your first job? When you were young, what did you want to be when you grew up? Who was your childhood hero? What was the make and model of your first car? What was the first concert you attended? Who is your favorite singer?
*Answer 2:
*Question 3:	Select... What was your childhood nickname? In what city did you meet your spouse/significant other? What is the last name of your favorite childhood friend? What street did you live on in third grade? What is your oldest sibling's birthday month and year? (e.g., January 1900) What is the middle name of your oldest child? What is your oldest sibling's middle name? What school did you attend for sixth grade? What was your childhood phone number including area code? (e.g., 000-000-0000) What is your oldest cousin's first and last name? What was the name of your first stuffed animal? In what city or town did your mother and father meet? What was the last name of your fourth grade teacher? In what city does your nearest sibling live? What was your first job? When you were young, what did you want to be when you grew up? Who was your childhood hero? What was the make and model of your first car? What was the first concert you attended? Who is your favorite singer?
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