2#**id**#Name#**label**#type_text#****#3#**id**#Best phone number to reach you#**label**#type_text#****#5#**id**#Practice location#**label**#type_text#****#9#**id**#Practice hours#**label**#type_matrix#****#10#**id**#How many weeks of  personal vacation taken annually?#**label**#type_spinner#****#11#**id**#How many ops for restorative?#**label**#type_text#****#12#**id**#How many ops for hygiene?#**label**#type_text#****#13#**id**#How long have you been practicing?#**label**#type_text#****#15#**id**#Do you own the practice? #**label**#type_own_select#****#1#**id**#type_submit_reset_1#**label**#type_submit_reset#****#