New Onboarding Intake Form

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 NameLast Name
OM Phone Number*
Please enter a valid phone number.
OM Email*
example@example.com
Regional Hygiene Contact

First NameLast Name
Regional Hygiene Email
example@example.com
Does your Company/Office work with an IT department?
Preferred Installation date

MonthDayYear
Date
IT POC Information to help with Installations
POC Information to help with Installations
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com

What Denti.AI service are you purchasing? (Please Select all that apply)*

Denti.AI VoiceDenti.AI DetectDenti.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)

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 operatory1 per providerWe will purchase our own microphones
Please choose your preferred model
Calculation

Denti.AI Detect/Auto-Chart Intake
How many operatories will be installed?*
Select which all providers who will need training?*

DoctorsRDHsDAs
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

Additional Info
Please provide any extra details relevant to your request
Should be Empty: