New Client Onboarding
Business Name:
Business Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Main Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Your Name
First Name
Last Name
Your email Address:
example@example.com
Will this email be used for accounts receivable?
Yes
No
Account Receivable (where invoices and estimates will go)
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Lets gather some network hardware information
Do you have a network closet?
Yes
No
Please Take a Photo of your network area
Do you have a Server?
Yes
No
Please take a photo of your Server?
Please input the Make/ Model/ Serial number of the server
Please list the amount of workstations in the office.
Please list the make of model of your workstations (bonus points for serial numbers)
Please list the make and model of your Firewall and Switches, you can take a photo of them if you wish by using the tool below.
Take a photo of your firewall and switches (this may be in the network closet photo from above)
Are you happy with the speed and coverage of the Wi-Fi in your business?
Yes
No
If no, please explain the areas where it is lacking
Who is your ISP (Internet Service Provider ie. Comcast, AT&T)
What type of internet do you have?
Cable
Fiber
DSL
Starlink
Other
What internet speed are you paying for? (normally located on your bill)
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Software Questions
Are you a Dental or Medical Office?
Yes
No
What is your practice management software? (check all that apply)
Dentrix
Open Dental
EagleSoft
Softdent
Denticon
Curve
Dentech
Other
What is your imaging software? (Select all that apply)
Dexis
Eaglesoft Imaging
DTX Studio
TigerView
Open Dental Imaging
VixWin
Anatamage
Other
Please list your sensors make and model and how many you have. (list all that apply)
Do you have a Pano?
Yes
No
Please list the make and model and specify if it is a CBCT 3D pano. Thanks!
Please list any other software related to your Dental or Medical Practice not listed above
Please list all software used in the course of regular business, cloudbased or server based.
If you can, Take Photo's of your operatories and add them here
If you can, Take Photo's of your operatories and add them here
If you can, Take Photo's of your operatories and add them here
If you can, Take Photo's of your operatories and add them here
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General Questions and Issues to Address
Do you wish to keep your office HIPAA or PCI compliant?
Yes
No
Please explain all the issues you have in your office now, that you wish for us to address first thing, AFTER the onboarding procedures are completed.
Do you have a IT provider now?
Yes
No
Please list their company name and contact name with email and phone number
Please explain why you are switching away from them and looking at other options. (you can be nice or mean, we wont share it)
Are you interested in a new website for your business?
Yes
No
Please type the URL for your website
Do you have professional emails now? That match your website address?
Yes
No
Who are your email service provider?
Google
Microsoft 365
Godaddy
Other
Do you have a 3rd Party Email security and point to point encryption service?
Yes
No
If so, please list the provider of the email security service
Are you willing to purchase and implement hardware and software procedures mandated by PCSI to be managed by PCSI? (note: all hardware is quoted with labor and approved by you before any installation is scheduled)
Yes
No
If no, please explain why
How will you be paying future invoices?
Credit Card (3% surcharge for all CC transations)
ACH
Check
If all of this sounds good, please sign below showing your willingness to work with us to ensure a smooth transition
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