New Onboarding Intake Form
Names and Contacts
Are you a part of DSO?
Name of the DSO?
*
Name of the Office?
*
Full Office Address? (Please include: city, state, zip/postal code)
*
Office Manager/ Point of contact
OM Name
*
First Name
Last Name
OM Phone Number
*
Please enter a valid phone number.
OM Email
*
example@example.com
Regional Hygiene Contact
First Name
Last Name
Regional Hygiene Email
example@example.com
Does your Company/Office work with an IT department?
Preferred Installation date
-
Month
-
Day
Year
Date
IT POC Information to help with Installations
POC Information to help with Installations
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
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What Denti.AI service are you purchasing? (Please Select all that apply)
*
Denti.AI Voice
Denti.AI Detect
Denti.AI Auto-Chart
What is your Practice Management Software?
*
PMS (name and version, i.e. Dentrix 23)
What is your Imaging Software?
*
Imaging Software (name and version, i.e. Dexis 9)
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Denti.AI Voice Intake
How many operatories will be installed?
*
Name and Contact information for each Provider
*
Will you need us to order Microphones on your behalf? If so, many microphones do you need? (Please Select One)
*
1 per operatory
1 per provider
We will purchase our own microphones
Please choose your preferred model
Calculation
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Next
Denti.AI Detect/Auto-Chart Intake
How many operatories will be installed?
*
Select which all providers who will need training?
*
Doctors
RDHs
DAs
Name and Contact information for EACH Doctor
*
Name
Name and Contact information for EACH RDH
*
Name and Contact information for EACH DA
*
Type a question
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Next
Additional Info
Please provide any extra details relevant to your request
Submit
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