Create you account | Dental Symphony

ACCOUNT SETUP FOR DENTAL OFFICES

Select Modules

Online Forms

Presentations

Perio Care

Add integration:

Terms of use

I agree to the Terms of Use. As required by federal statutes including HIPAA/HITECH governing the protection and privacy of personally-identifiable patient information, a Business Associate Agreement (BAA) is included in this Terms of Use. I understand that the BAA obligates Dental Symphony to undertake certain obligations regarding the protection and safeguarding of such information for our dental office.

I affirm I am either the sole principal of my own dental practice or a principal of a dental practice authorized to enter into contracts on its behalf.

Billing Information

Dental Symphony is a monthly subscription service reserved for licensed dental professionals. Upon creating your account you will be charged for the first month of use. However if within the first 30 days you are not satisfied, you can unsubscribe or notify your Dental Symphony representative for a refund of your first month's subscription.

*First Name:

Middle Name:

*Last Name:

*E-Mail Address:

*Phone Number:

*Credit Card number:

*CVC2/CVV2:

*Expiration date:

*Address:

*City:

*Postal / ZIP Code:

State:

Country:

Account Information

Please choose the unique Site Name for your Dental Symphony account. For example, if you choose doctor as your Site Name your Dental Symphony account URL will be https://doctor.dentalsymphony.com.

* Site name

Choose your account username to log in (letters and numbers are allowed; no spaces or symbols, please).

* Username:

Create a Password. 6-20 characters are required. A combination of alphanumeric and special characters are recommended.

* Password:

* Confirm Password:

Please enter a discount code if available.

Discount:

Please select your practice type.

Practice type:

Please select your practice management system.

Practice Management System:

Whom may we thank for suggesting Dental Symphony?

Please provide name and e-mail address if available: