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SCHEDULING LINK
HIPAA
Compliance
1
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2
HAVE YOU BEEN SEEN BY DENTACOR IN THE PAST?
YES
NO
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3
WHAT IS YOUR NAME?
First Name
Last Name
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4
WHAT IS YOUR DATE OF BIRTH?
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Date
Month
Day
Year
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5
DO YOU HAVE AN ACTIVE PHONE?
YES
NO
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6
WHAT IS YOUR PHONE NUMBER?
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7
DO WE HAVE PERMISSION TO TEXT APPOINTMENT REMINDERS AND/OR APPTOINTMENT SPECIFIC COMMUNICATIONS?
YES
NO
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8
CLICK "ALL" SERVICES YOU ARE INTERESTED IN RECEIVING:
click ALL services that apply
EXAM
CLEANING
DENTURES
EXTRACTION ASSESSMENT
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9
CLICK NEXT TO SCHEDULE
APPOINTMENT LOCATION
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10
SELECT PREFERRED APPT LOCATION:
EVERY WEDNESDAYS
EVERY THURSDAY
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11
SCHEDULE YOUR SALT LAKE LIBRARY APPOINTMENT:
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12
SCHEDULE YOUR WEST JORDAN D.O.C. RESOURCE FAIR APPOINTMENT:
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13
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14
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