What is the true cost of your practice management system?

Practice Expense	Monthly Cost
Current Practice Management System
Support Plan
Integrated Digital Imaging
Claims
Attachments
Electronic Eligibility Verification
Online Forms
Customizable Reporting
eStatements
Online Booking
Patient Reminders
Two-Way Texting
IT Services (Server Maintenance)		NA
TOTAL	$0

How many locations in this organization?

Number of employees who need access to practice management system?

Practice Information

Primary Contact First Name

Primary Contact Last Name

Phone

Zip

Practice Name

HSD Customer Number

Did you work with a Henry Schein Dental consultant on this evaluation? Yes

Henry Schein Dental Consultant Name