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Pre-Installation Form (New Clients)
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Pre-Installation Form (New Clients)
Pre-Installation Form (New Clients)
1
General Information
General Information
Please fill out the following information as best you can
What Practice is this for?
Preferred Install Date
Date will be set here
Number and Person to contact for the Installation (Requires Admin Server Credentials)
List the names of the Providers who will have an online scheduling profile with LocalMed:
How would you like returning patients to view recall openings:
An option will be selected here
How long do you schedule New Patient Cleanings for adults?
An option will be selected here
How long do you schedule New Patient Cleanings for children?
An option will be selected here
How long do you schedule Returning Patient Cleanings for children?
An option will be selected here
How long do you schedule Returning Patient Cleanings for adults?
An option will be selected here
How long do you schedule New Patient Emergency/ToothPain?
An option will be selected here
How long do you schedule Returning Patient Emergency/ToothPain?
An option will be selected here
How long do you schedule New Patient Consultation? (Copy)
An option will be selected here
What is the name of the person or company who created and manages your website?
Are you in Network with United concordia?
An option will be selected here
Do you offer Six Month Smiles or Invisalign as an option to your patients?
An option will be selected here
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