Onboarding Form
 
Your information is encrypted and processed through HITRUST CSF certified technology for HIPAA compliance.
 

First name:

 
 

 

Last name:


 

Dental license #


 

Dental license state


 

Cell phone:


 

Office phone:

 
 

 

Email address


 

Do you have previous experience with Clear Aligner Therapy (CAT)? If so, which companies? (Select all that apply)

 Inivisalign
 Clear Correct
 Suresmile
 Other

Other:


 

Have you ever placed an orthodontic composite attachment for CAT?


 

Have you performed Interproximal reduction (IPR) on a patient for CAT?


 

 I have read and agree to the Master Service Agreement (MSA)
 I have read and reviewed Exhibit A
 I have read and reviewed Exhibit B
 I have read and reviewed Exhibit C

After you submit the onboarding form, a welcome email will be sent to the email address you provided. This email will include copies of the Master Service Agreement (MSA), Exhibit A, and Exhibit B, along with the link to submit a case online.