In order to create a smart dental savings plan for your office, we start by evaluating your New Patient visit and 6-month follow-up visit. We also look at the patient's second year in your practice to be sure we design a plan that encourages retention.
Please complete the following form to help us get started!
Please list your standard fee for all service you actually bill the patient at a first time visit. For example, if you take a pano and an FMX but only bill the patient for one, please enter "$0" for the service you do not charge. If you do not usually perform the listed service, please check the box "N/A" instead of adding a dollar amount. You are able to add additional services and add your comments if you have additional information we should know.
D0150
D0210
D0330
D1110
D1206
Other
D0120
D0274
Maximum file size: 50MB
Is there anything else about your preventive services or patient experience that you would like us to know?
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© Copyright SmileMore DSP | All rights reserved.