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* 1. Please enter your contact information below.

Please complete the remaining questions if you have a specific case you would like to present for discussion. Otherwise, please hit submit at the bottom of the page to secure your registration.

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* 2. Brief case summary (please do not include any PHI):

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* 3. Specific clinical question(s) you would like to discuss:

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* 4. Does your case require images to be presented?

T