Go to the Home page
How Online Dental Forms work Why Online Dental Forms work Frequently Asked Questions See a demonstration, tryout forms About Us Signup for our SecureDentalForms!

Thank you for signing up for our basic service. This form will calculate your initial cost, collect some basic information so we can begin setting up your account.

Practice Name *
Dr Name *
Office Contact Name *
Email Address *
Web Site Address *
Office Address *
City *
State *
Zip *
Phone *
Fax *
Practice Management Software *
Do you know of any colleagues that might be interested in Secure Dental Forms?
Type of Forms requested  
Fee of $349 covers converting 5 of your forms to PDF, each additional form will be $75 per form.
Bill Me
Cost is $49 per month, may be paid annually
 

PRICING
Service
$49 per month recurring charge or annual billing depending on your preference above.
0
Forms 0
Total 0
If you choose PDF forms, $349 will be charged today for forms setup. $49 will be billed on 2/9/2018 (60 days from today) if you selected Monthly. If you selected Annual Billing then $588 will be billed on 2/9/2018 (60 days from signup date).
*  By checking this box and submitting the following information to Secure Dental Forms you agree to accept these charges.
Please note that the company name on your credit card statement will be Advanced Automation, Inc.
Your Name (signature) *











divide
Make life easier for your patients and your staff. Go paperless today!
spacer
Go paperless today! Secure Dental forms are HIPAA compliant, easy to setup, and easy for patients to use. Provide the utmost privacy and convenience to your patrons with the option to fill out forms online while at their home or office.
Some of the forms we
provide
are:
spacer
New Patient Information
Payment Policy
Privacy Policy
General Health History
Dental History
Customized Securedentalforms
for your practice.
spacer
While we offer standardized, precon-figured forms, we will galdly create customized forms to suit the specific needs of your practice. Please contact us now to discuss your needs, and we will create a custom package specically for you!

©2008 Advanced Automation, Inc.