Secure Online Form Questionnaire Secure Online Forms Questionnaire Step 1 of 4 25% Payment ConfirmedThank you for submitting your purchase of Secure Online Forms by ClearPG. Please continue the next steps below to expedite the setup of your account.Secure Online Forms: QuestionnaireThis is where you’ll give us all the basic information about your orthodontic practice and authorized users from your office. We’ll use this information to set up your Secure Online Forms' profile, all of your branding, and finally your messaging templates. This goes a long way towards getting you started!What is your office name? * Required What is your website url? Upload Several Copies of Your Logo Drop files here or Select files Max. file size: 100 MB, Max. files: 5. Maximum file size - 100 mega bytes. How Can We Contact You?What email can we use to reach you? * Required We will use this email address to send any communication about your forms and setting up access to your dashboard.PhoneWhat email(s) will need access to your form submissions and dashboard? * Required A comma separated list of email addresses you would like to have access to your dashboard and submissions. These can be managed and updated later by you.What email(s) will need to be sent form completed notifications? * Required A comma separated list of email addresses you would like form notifications sent to once a patient completes their forms. Our Standard Form Completion NotificationBelow is our standard form completion notification, this is the information patients will see once completing any of your forms. Please submit any changes you would like to see here.Requested Changes or Comments To Our Standard Form Completion Notification: You have finished the new patient form and it has been submitted to our office. Thank you! Additional Form CustomizationsPlease submit any changes you would like to see here. The more information you can provide the better. Thank you!Details about the additional formYou have finished the new patient form and it has been submitted to our office. Thank you! Please include any details about the form you would like added. Or examples of other websites that have the form you are trying to create.Attach an example(s) of the additional form you are trying to create Drop files here or Select files Max. file size: 100 MB, Max. files: 5. Maximum file size - 100 mega bytes.
