{"id":11539,"date":"2017-07-05T21:09:30","date_gmt":"2017-07-05T21:09:30","guid":{"rendered":"https:\/\/www.process.st\/templates\/pre-installation-form-new-clients\/"},"modified":"2024-02-28T20:45:55","modified_gmt":"2024-02-28T20:45:55","slug":"pre-installation-form-new-clients","status":"publish","type":"post","link":"https:\/\/www.process.st\/templates\/pre-installation-form-new-clients\/","title":{"rendered":"Pre-Installation Form (New Clients)"},"content":{"rendered":"<section id=\"general-information\">\n<h2> General Information <\/h2>\n<div class=\"text-content\">\n<p>Please fill out the following information&nbsp;as best you can<\/p>\n<\/p><\/div>\n<div class=\"text-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> What Practice is this for? <\/label><br \/>\n   <input type=\"text\" placeholder=\"Something will be typed here...\" disabled=\"disabled\" class=\"form-control\" \/>\n  <\/div>\n<\/p><\/div>\n<div class=\"date-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Preferred Install Date <\/label> <\/p>\n<div class=\"date-container\">\n    <button type=\"button\" disabled=\"disabled\" class=\"btn btn-default\"> <i class=\"fa fa-calendar btn-icon\"><\/i> Date will be set here <\/button>\n   <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<div class=\"text-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Number and Person to contact for the Installation (Requires Admin Server Credentials) <\/label><br \/>\n   <input type=\"text\" placeholder=\"Something will be typed here...\" disabled=\"disabled\" class=\"form-control\" \/>\n  <\/div>\n<\/p><\/div>\n<div class=\"textarea-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> List the names of the Providers who will have an online scheduling profile with LocalMed: <\/label><br \/>\n   <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled=\"disabled\" class=\"form-control\"><\/textarea>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> How would you like returning patients to view recall openings: <\/label><br \/>\n   <select disabled=\"disabled\" class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> How long do you schedule New Patient Cleanings for adults? <\/label><br \/>\n   <select disabled=\"disabled\" class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> How long do you schedule New Patient Cleanings for children? <\/label><br \/>\n   <select disabled=\"disabled\" class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> How long do you schedule Returning Patient Cleanings for children? <\/label><br \/>\n   <select disabled=\"disabled\" class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> How long do you schedule Returning Patient Cleanings for adults? <\/label><br \/>\n   <select disabled=\"disabled\" class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> How long do you schedule New Patient Emergency\/ToothPain? <\/label><br \/>\n   <select disabled=\"disabled\" class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> How long do you schedule Returning Patient Emergency\/ToothPain? <\/label><br \/>\n   <select disabled=\"disabled\" class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> How long do you schedule New Patient Consultation? (Copy) <\/label><br \/>\n   <select disabled=\"disabled\" class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"text-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> What is the name of the person or company who created and manages your website? <\/label><br \/>\n   <input type=\"text\" placeholder=\"Something will be typed here...\" disabled=\"disabled\" class=\"form-control\" \/>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Are you in Network with United concordia? <\/label><br \/>\n   <select disabled=\"disabled\" class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Do you offer Six Month Smiles or Invisalign as an option to your patients? <\/label><br \/>\n   <select disabled=\"disabled\" class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<\/section>\n","protected":false},"excerpt":{"rendered":"<p>General Information Please fill out the following information&nbsp;as best you can What Practice is this for? 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