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NEW CLIENT QUESTIONAIRE
Company Name
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How did you hear about us?
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Google Search
OpenDental Blog
Dentaltown
AADOM
Reference
Nifty Thrifty
Nifty Thrifty 8/30 Live
Dental Success Network
Business of Dentistry
The Making of a Dental Startup
Other
Name
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Email
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Phone
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Do you have a staff member(s) that you prefer as the Point of Contact?*
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Yes (please include in notes)
No
Address
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How do you wish to be contacted?
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Email
Call
Text
The Reuben Demo
What practice management software do you use?
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Dentrix
Eaglesoft
OpenDental
Carestream
other - non cloud based
other - cloud based
Do you have a Dental Specific IT Provider?
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Yes
No
I Don't Know
What made you look for a new IT provider?
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Do you have Firewall that is up to date?
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Yes
No
I'm Not Sure
Do you have Anti-Virus Software that logs all attacks?
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Yes
No
I'm Not Sure
Do you have an Secure Off and On-Site Backup System?
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Yes
No
I'm Not Sure
Do you test your backups to see if they can be recovered from?
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Yes
No
I'm Not Sure
Do your train your staff on HIPAA Compliance?
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Yes
No
I'm Not Sure
Do you complete an Annual Risk Assessment?
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Yes
No
I'm Not Sure
How can we help you?
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