Open Dental Conversion Information

Software Setup Data

This form allows me to more effectively setup your database. Please be as detailed as possible.

This field is for validation purposes and should be left unchanged.

Practice Information

Todays Date(Required)

Name(Required)

First Last

Office Name(Required)

Name of Person Completing This Form(Required)

Cell Phone(Required)

Email(Required)

Website

Additional Contact Name

Additional Contact Number

Please select the specialty below. Only select multiple if you have a licensed professional in that specialty.

If you are a specialist office and need to have custom letters for referral sources, please upload a template of them in the online forms section.

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name(Required)

First Last

Email(Required)

Phone(Required)

Microsoft Login – this is the login you would use when you first open your computer(Required)

You are welcome to create one specific for me, or share an existing one for the office that has administrative access. Please include the user and password

Current Practice Management Software(Required)

ie. Dentrix, Eaglesoft, PracticeWorks, or new start up with Open Dental

Existing Software Administrative Login(Required)

You are welcome to create one specific for me, or share an existing one for the office that has administrative access. Please include the user and password

Are you switching to Open Dental's Imaging Software? This comes standard with Open Dental at no extra fee. I will need to make custom xray and intraoral templates for the office.(Required)

If you plan to use your existing 3rd party, Open Dental will need to bridge the software.

Existing Xray Software(Required)

Do you use Autonotes in your existing software?(Required)

Yes

Other

Will you need Autonotes setup in Open Dental?(Required)

I will need Stephanie Wright Practice Management to use existing autonotes templates and add them into Open Dental

I will have a team member create the autonotes in Open Dental

Other

Will you use Open Dental E-Services?(Required)

Yes

Other

What E Services are you signing up for?(Required)

Patient Communications(Required)

I want Stephanie Wright to customize patient communications

I will have a team member customize patient communications

Other

Online Forms(Required)

I will have Stephanie Wright Practice Management Create Our Online Forms With Existing Templates

The Office Will Have A Team Member Create Online Forms

I will not be using Open Dentals Online Forms

Patient Forms(Required)

Drop files here or

Max. file size: 50 MB.

Please upload every patient form including Health History Update, New Patient Forms, HIPAA, Consents and Registration forms that you would like made into an Open Dental Form

List of Labs you use and what you use them for. Any specific tech you work with, phone number and email address.(Required)

List of top referrals for specialty care, the office name, the clinicians names, address, phone number, email address(Required)

Insurance Fee Schedules

Drop files here or

Max. file size: 50 MB.

Please do not upload fee scheduled printed from your current software

Employee Information

Will you use Open Dental's Time Clock For Payroll?(Required)

Yes

Please select your payroll frequency(Required)

Weekly

Bi-Weekly

Monthly

Other

First Date of Payroll Cycle After The Final Conversion(Required)

Date that your employees are paid after the payroll cycle above(Required)

Please upload a list of your team member names, their position, how they are listed in open dental (ei. rec1, hyg2) and what operatories they work out of if they are a provider of care, their weekly schedule.

Drop files here or

Max. file size: 50 MB.

I have listed the basics for Open Dental Setup. There are many advanced features and functionalities I have not included as this can often be overwhelming. If you would like more information or another function setup, please list it below: