Locations
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Locations
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You’ve chosen to enroll
4 locations
with eAssist services.
Location 1
Location 2
Location 3
Location 4
Location 1
Location or Practice Name
Office Phone
Street Address 1
Street Address 2
City
State
Zip
Select a point of contact for this location:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Number of Doctors
1
2
3
4
5
Number of Hygienists
1
2
3
4
5
Number of Other Employees
1
2
3
4
5
Avg Monthly Production for Location
Avg Monthly Insurance Collections for Location
Avg Monthly Collections for Location
Estimated Over 90 AR Balance for Location
Select a point of contact for this location:
Carestream Cloud
Cloud9
Curve
Dentec
Denticon
Dentrix
Dentrix AscendDentrix Ascend
Dentrix Enterprise
DOX
DSN
Eaglesoft
Easy Dental
EndoVision
Fuse
Genesis
iDental Soft
Mac Practice
Medisoft
OMS Vision
Open Dental
Ortho2Edge
OrthoTrac
Oryx
Practice Works
TDO
TOPS
WinOMS
Have you changed your practice management software within the last two years?
Yes
No
I’m not sure
What services doest this practice provide?
Select all that apply:
General dentistry
DMO
DentiCal
100% FFS
Delta Dental of IL
HMO
Borrego
100% OON
What services doest this practice provide?
Select all that apply:
General dentistry
Endodontics
Periodontics
Orthodontics
Pediatric
Oral surgery
Business hours
(optional)
Day (s)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Open time
From
12:00AM
1:00AM
2:00AM
3:00AM
4:00AM
5:00AM
6:00AM
Close time
To
12:00AM
1:00AM
2:00AM
3:00AM
4:00AM
5:00AM
6:00AM
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