Welcome!
Select the appropriate program below to begin.....
Important:
- You can save a draft of your work if you would like to finish filling out the form at a later date or to make edits.
- Be sure to read the instructions for your program to ensure timely submission.
- Follow-up regarding your submission will be provided to your Heartland email account. Please be sure that you check your emails regularly.
- Please reach out to Submittable's Customer Support team with any technical questions at support@submittable.com.
Case Submission Guidelines
- Case # - Participant Name - State Abbreviation
Required Documents: requires the following (legible) documents for case approval:
- Patient Health History and Patient Medical Release Form
- Diagnostic Quality FMX, Pano, PA of Implant Site, (Optional Kentucky Conebeam or Kansas Cat scan with calipers)
- Diagnosis and Periodontal Health Status
- Poured Models, Copy of Full Arch Scans (Export STL File Instructions), or Intraoral photo of Probe measurements
Approval Guidelines: Cases will be approved and ranked based on the surgical difficulty level scale of 1 to 5.
- (Slight to moderate difficulty 1-3) = automatic approvals
- (Above moderate difficulty 4) = Clinical Director approval required
- (High degree of difficulty 5) = will not be approved
Please allow 7-10 business days for an email response from your mentor.
Course Requirements
Cases must be submitted with all required documents and approved by the host mentor before your workshop date
Cases will be approved and ranked based on the difficulty level on a scale of 1 to 5.
- 1-3 are automatic approvals
- 4 requires Clinical Director approval
- 5 is not approved
You must register and submit your cases at least 2 weeks prior to the workshop to receive appropriate supplies.
Review page 2 of the Clinical Foundations Workshop Flyer prior to completing this form to select the correct Workshop
The following documentation is required for case approval:
Documentation is required for each patient. Cases submitted without proper documentation will be automatically rejected
For each case submission, you will use a new submission form.
- Patient Health History
- Signed Patient Medical Release Form
- Pano, FMX, BW's, PA of teeth to be treated
- Intraoral Photos
- Diagnosis, Teeth #'s, and Perio Health Status
Reminder: All procedures must be approved and completed and a post-op endo PA submitted to receive CE Credit.
The post-op PA needs to be submitted through a separate Submittable portal on the day of the workshop