Clinic Survey - DentalX

Clinic Information

Let's start with the basics about your dental clinic

Clinic Name *

Contact Person Name *

Email *

Phone Number *

City *

State *

Preferred Contact Method *

Clinic Details

Tell us more about your clinic's size and operations

Number of Dentists *

Number of Chairs *

Support Staff *

Average Patients/Day *

Type of Practice *

Current Setup

What software and systems do you currently use?

Current Software *

Software Name (if applicable)

What are your biggest challenges? (Select all that apply)

Appointment Scheduling

Billing & Payments

Patient Records

X-ray/Imaging Management

Inventory Management

Reports & Analytics

Additional Comments

Feature Priorities

Rate how important these features are for your clinic (1 = Not Important, 5 = Very Important)

Patient Management System

Not ImportantVery Important

Appointment Scheduling

Not ImportantVery Important

Billing & Invoicing

Not ImportantVery Important

Inventory Management

Not ImportantVery Important

Treatment Planning

Not ImportantVery Important

Digital X-Ray Integration

Not ImportantVery Important

AI-Powered Diagnostics

Not ImportantVery Important

Clinical Decision Support

Not ImportantVery Important

Reporting & Analytics

Not ImportantVery Important

Multi-Location Support

Not ImportantVery Important

Mobile App

Not ImportantVery Important

SMS/Email Reminders

Not ImportantVery Important

Budget & Pricing

Help us understand your budget expectations

Monthly Budget Range *

Preferred Pricing Model *

Willing to Pay per Month (Optional)

Implementation Timeline

When are you planning to implement a new system?

Implementation Timeline *

Training Requirements *

Do you need data migration from existing system?

Compliance & Security

Your data security and compliance requirements

Compliance Requirements (Select all that apply)

HIPAA Compliance

GDPR

Local Data Protection Laws

ISO Certification

Data Hosting Preference *

Final Details

Just a few more details to complete your survey

Overall Interest Level *

How did you hear about DentalX?

Additional Features or Requirements

Any additional comments or questions?

Thank you for your time! Click "Submit Survey" below to send your responses. Our team will review your information and contact you within 24 hours.

Clinic Requirements Survey

Clinic Information

Clinic Details

Current Setup

Feature Priorities

Budget & Pricing

Implementation Timeline

Compliance & Security

Final Details