Step 1.

Dolphin Imaging and Management Solutions is a Continuing Education (CE) Registered Provider, under Title 16 California Code of Regulations, Section 1016. In order to received CE Credits for a Dolphin course you must be current on your support contract and complete the following form and submit to our corporate headquarters.

*Course Title:

*Date Course Provided:

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*First Name:

*Last Name:

*Phone:

License#/Registration#:

*Email Address:

*Practice Name/Institution:

*Address:

*City:

*State/Province:

*Postal Code:

Country: