Software Implementation Guide - Getting to Know You

Software implementation: Getting to Know You

The information in this form is confidential and may be legally privileged. It is intended solely for the addressee(s). Access to this e-mail by anyone else is unauthorized.

Conversion Information:

Please fill in the information below and submit before the planning call!

Customer ID / JDE Number

Practice Name

Hours of Operation

General/Specialty?

Please Explain

Primary Office Contact

First person we will try to contact if there are questions during the implementation.

Name

Phone Number

Secondary Office Contact

If primary contact cannot be reached, especially after business hours

Name

Email Address

Cell Phone

IT Contact

This person takes care of your computers

Name

Phone Number

Email Address

Number of Team Members That Will Be Using the Software

Doctors

Administrative

Hygienists

Assistants

Other

Does anyone have Dentrix knowledge?

Who has prior experience with Dentrix?

Current Server Computer Information

Server Computer Admin Login Name

Server Computer Admin Login Password

What is Imaging software and versions the office using for X-rays?

Is that changing later on?

If yes, what is the new Imaging software and version?

Software/Program and Practice Information

Current Appointment Time Increments
5 10 15 20 30

Standard Conversion Customization Options

If you do not want these options, please mark “No”. Any requests outside of the standard options may have an additional fee.

Remove my account balances by changing all amounts to zero Yes No

Inactivate patients that have a last visit date prior to specified date: Yes No

When should we inactivate the patients? (M/D/Y)?

Remove all Insurance? (Insurance Carriers and links to patients)

Remove all Employers? (Employers and the links to the patients)

Remove all Treatment Plans?

HIPAA Check

Please provide the full names of two providers and their provider IDs in your database to match exactly how it is seen in your software currently. This will be used to verify the validity of your database after the conversion.

Current Provider ID 1 (i.e. DDS1)

Current Provider 1 Name

Current Provider ID 2 (i.e. HYG1)

Current Provider 2 Name

Software implementation: Getting to Know You

Thank you

Conversion Information:

Primary Office Contact

Secondary Office Contact

IT Contact

Number of Team Members That Will Be Using the Software

Current Server Computer Information

Software/Program and Practice Information

Standard Conversion Customization Options

HIPAA Check

Resources