ACCOUNT SETUP FOR DENTAL OFFICES Select Modules Please select at least one Module. Online Forms Presentations Perio Care Add integration: None Dentrix G7+ Eaglesoft Open Dental Open Dental with Payments Dentrix Ascend 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. You must accept the terms of use. You must confirm that you are owner or principal of a dental practice. 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: First Name is required. Special symbols are not allowed. Middle Name: Special symbols are not allowed. *Last Name: Last Name is required. Special symbols are not allowed. *E-Mail Address: E-Mail Address is required. E-Mail Address has incorrect format. *Phone Number: Phone is required. Phone Number has incorrect format. *Credit Card number: Credit Card is required. Incorrect Credit Card number (no spaces, no dashes). *CVC2/CVV2: CVC2/CVV2 is required. Incorrect CVC2/CVV2 format. *Expiration date: 1 2 3 4 5 6 7 8 9 10 11 12 / 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 *Address: Address is required. *City: City is required. *Postal / ZIP Code: Zip Code is required. State: Region: 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: Username is required. Create a Password. Minimum of 8 characters and includes the following: ● include at least one letter ● include at least one number ● include at least one special character * Password: Password is required. Password should be minimum eight characters, at least one letter, one number and one special character. * Confirm Password: Confirm Password is required. Passwords do not match Please enter a discount code if available. Discount: Please select your practice type. Practice type: General Pediatric Orthodontist Periodontist Endodontist Oral maxillofacial surgery Prosthodontics Dental radiologist Oral pathologist Please select your practice management system. Practice Management System: None Curve Denticon Dentisoft Dentrix Ascend Dentrix Enterprise Dentrix No Integration DSN Eaglesoft Easy Dental MacPractice Open Dental Other PerioExec Practice Works SoftDent WinOMS Whom may we thank for suggesting Dental Symphony? Please provide name and e-mail address if available: Please confirm you are not a robot
