Initial Qeustionnaire

Dr. Name *

Dr's Email *

Manager *

Dr's Cell *

Office Phone *

Monday *

Friday *

Tuesday *

Saturday *

Wednesday *

Sunday

Thursday *

Number of Dentists *

Number of Hygienists *

Other (please specify) *

What dental management software are you using? *

What insurance providers are you contracted with?

Indemnity Plan

Government Plan

How many patients do you see on average per day? *

What is the outstanding dollar amount of your aging report? *

How many new patients are you onboarding each month? *

What is the outstanding dollar amount of your insurance aging report? *

What has been your average monthly insurance collection over past 6 months? *

Thank you for your message. It has been sent.

There was an error trying to send your message. Please try again later.