Quick Add

DENTACOR SIGN-IN

CLICK BELOW TO START A NEW SIGN-IN

IS PATIENT SIGNING THEMSELVES IN?

SIGN IN NOW

PATIENT SIGNING THEMSELVES IN

TEAM MEMBER SIGNING PATIENT IN

RETURNING

ARE YOU A RETURNING OR A NEW PATIENT?

HOW DID YOU HEAR ABOUT DENTACOR?

CASE WORKER

THE LIBRARY

HOUSING AUTHORITY

FRIEND/FAMILY MEMBER

FACILITY

FACEBOOK AD

OtherOther

DENTACOR TEAM MEMBER (INDICATE NAME)DENTACOR TEAM MEMBER (INDICATE NAME)

ARE YOU A RETURNING OR A NEW PATIENT?

NEW PATIENT

RETURNING PATIENT

VERIFY NOT A DUPLICATE

PLEASE LOOK IN SLACK TO ENSURE PATIENT IS NOT ALREADY IN THE SYSTEM

IS THERE A DUPLICATE

SLACK NON-DUPLICATION VERIFIED

DI #

COPY & PASTE DI#

(CAN BE FOUND IN APPT DETAILS IF HAS A SCHEDULED APPT OR IN SLACK CHANNEL)

PROVIDE DI#

CLICK HERE TO WHEN DI# HAS BEEN ADDED

NEW PATIENT STATUS VERIFIED, CONTINUE WITH SIGN-IN

WHERE IS APPT

WHERE IS YOUR APPOINTMENT LOCATED?

CLICK TO SELECT THE LOCATION YOU WILL BE ATTENDING YOUR APPT?

Patient Name

Date of Birth

Phone

Email

No Phone Available

No Email Available

Insurance Company

CLICK BELOW ONCE YOU HAVE ADDED ALL REQUIRED INFORMATION HAS BEEN ADDED

POLICY #

UPLOAD PIC OF INSURANCE

Maximum file size: 516MB

CLICK HERE WHEN INFO HAS BEEN ADDED

WHEN WAS THE LAST TIME YOU VISITED THE DENTIST?

WHAT IS YOUR PRIMARY REASON FOR MAKING THIS APPT TODAY?

GENERAL EXAM & CLEANING

WOULD LIKE DENTURES

WOULD LIKE EXTRACTIONS & DENTURES

OtherOther

ARE YOU CURRENTLY MISSING TEETH?

NO, NOT MISSING TEETH

MISSING SOME TEETH

MISSING MANY TEETH

MISSING ALL TEETH

DO YOU CURRENTLY HAVE A DENTURE?

YES, UNDER 5 YEARS OLD

YES, OVER 5 YEARS OLD

NO, DO NOT HAVE DENTURE

IS YOUR APPT TODAY?

CLICK HERE IF YOUR APPT IS TODAY

NO SCHEDULED APPT TODAY

DOES PATIENT HAVE A SCHEDULED APPT TODAY?

APPT TODAY?

PATIENT ALREADY HAS A SCHEDULED APPT

PATIEN DOES NOT HAVE A SCHEDULED APPT TODAY

APPT TIME

Denture Appointment Type

Initial Scan

Wax Rim

Seating

Adjustment

Event Date

Time

LOCATION OF APPT

WHERE DOES PATIENT GO NEXT?