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Home
Representative Portal
Lead Submission
Resources
Practitioner Store
Flow charts
Search
Submit your contact leads in order to lock in your commission in our system
Your Information
*
Indicates required field
Your Name
*
First
Last
Your Email
*
Please CC me in contact with my lead that doesn't contact HPI.
*
Yes
No
Lead Information
Name
*
First
Last
Email
*
Are we allowed reach out to this lead?
*
Emailing is okay
Phone Call is okay
No
Phone Number
*
Description of Interest
*
Have you demo'd/treated this lead?
*
with Avazzia
with QRS
with other modalities
No
No, but I have provided them an explanation on technology
Submit
We promise to not contact our lead without your permission
Use their information in any third party way
Market to your lead without your permission
Home
Representative Portal
Lead Submission
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