• OSI Surgical Skills Assessment

  • Doctors please take a few minutes and answer this questionnaire so we can determine your level of experience and match your surgical skills with the patients that will be assigned to each one of you. Honesty is a must and your answer will ensure that your training will be successful.

    Overselling your self is a common mistake. If we assign you complex cases that are above what you can perform, you may not have the experience you are signing up for.

  • Personal Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • What procedure are you coming to CSI for?
  • What is your current professional role in dentistry?
  • Are you member of any of the following implant academies?

  • General Oral Surgery Experience

  • In Your Practice, Do you perform simple extractions? What Frequency?*
  • Do you perform Phlebotomy and or use PRP/PRF in your office (check all that apply).
  • Do you have advanced cardiac life support training?

  • Specific Hands-On Experience with Implants

  • Are you placing implants now?

  • Technology Usage

  • Do you own a CBCT? Or work closely with scanning center?*
  • Are you or have you used a 3D printer?*
  • Do you know how to convert Dycom files into 3D models?*
  • Xray (wall mounted or handheld), Xray Sensor*
  • Photogrammetry (Icam) or Analog Conversion (Neoconvert)*
  • Intraoral Scanner*
  • Loupes or Headlight (Check all that apply)*
  • Are you interested in learning how to plan “virtual surgeries" ?*

  • What Supplies Do You Currently Use in Your Office?

  • Non Resorbable or Resorable*
  • Bone Graft*
  • Sutures*
  • Over Denture / Locator*
  • Lateral / Vertical Sinus Kit*
  • Block Graft Kit*
  • Screw / Tack Kit*
  • Forceps / Elevators*
  • Air Polisher*

  • Confidential Information

  • Have you ever been reprimanded by the dental board?*
  • If yes, license suspended or revoked?*
  • Do you have problems with alcoholism or drug addiction?*

  • Surgical Level Classification

    As a general rule: Novice or beginners have placed less than 50 implants Intermediates have placed between 50-100 implants Advanced have placed over 200 implants.
  • How would you classify your surgical level?*

  • What are you OSI Expectations

  • Should be Empty: