Sentinel Professional Office Enrollment
Complete this one-time form to establish your office for digital case submissions. Sentinel will confirm your account before accepting cases.
Practice Name
*
Name of the dental office or practice.
Primary Contact Name
*
First Name
Last Name
Primary Contact Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Supervising Dentist / Practice Owner Name
*
First Name
Last Name
Dentist License Number
*
State Where License Is Issued
*
Authorization
*
I confirm that I am authorized to enroll this dental practice and that the supervising dentist listed above holds an active license.
Submit
Should be Empty: