Company Name
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Name
*
Email
*
Phone
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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What practice management software do you use?
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Dentrix
Eaglesoft
OpenDental
Softdent/Practiceworks
Other - non cloud based
Other - cloud based
Do you have a Dental Specific IT Provider?
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Yes
No
I don't know
Do you have Firewall that is up to date?
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Yes
No
I don't know
Do you have Anti-Virus Software that logs all attacks?
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Yes
No
I don't know
Do you have an Encrypted Off and On-Site Backup System?
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Yes
No
Do you test your backups to see if they can be recovered from?
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Yes
No
Do your train your staff on HIPAA Compliance?
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Yes
No
Do you complete an Annual Risk Assessment?
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Yes
No
How can we help you?
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