Pilot Program ApplicationStep 1: Contact and PracticeSome description about this sectionFirst NameLast NameJob Title / Role- Select -Practice OwnerDentistOrthodontistPractice ManagerOffice ManagerTreatment CoordinatorIT or Technology LeadConsultantOtherDirect Phone NumberBusiness EmailPreferred Contact Method Email PhonePractice NamePractice WebsitePractice Type- Select -General Dental PracticeOrthodontic PracticeMulti-Specialty Dental PracticePediatric Dental PracticePeriodontic PracticeOral Surgery PracticeEndodontic PracticeProsthodontic PracticeDental Service Organization or GroupOther Dental SpecialtyPractice Status Currently operating Opening within three months Opening within three to six months Early planning stageAddressCityProvinces / Territories / StatePostal/Zip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweNumber of Locations0Approximate Number of Team Members- Select -1–56–1011–2021–50More than 50PreviousNextStep 2: Current Environment and NeedsSome description about this sectionWhat practice management software do you currently use?- Select -DentrixDentrix AscendCurve DentalOpen DentalTrackerAbelDentClearDentMaxidentDolphin ManagementOrtho2Cloud 9Another practice management systemWe use multiple systemsWe do not currently use practice management softwarePrefer not to sayAre you currently considering replacing your practice management software? Yes, as soon as possible Yes, within the next 3 months Yes, within the next 6 months Yes, but we do not have a fixed timeline We are opening a new practice and do not have an existing system We are exploring available options No, we are not currently planning to replace our systemCan your practice participate without importing historical data from your current system? Yes Yes, if we can begin with a limited or clean environment Unsure—we would like to discuss the setup requirements NoWhat are the main challenges with your current software or workflows? Too many disconnected systems Difficult or inefficient appointment scheduling Patient information is difficult to find Clinical documentation takes too much time Billing and payment workflows are inefficient Insurance workflows are too manual Patient communication requires too much staff effort Reporting is limited or difficult to use Multi-location management is challenging Current software is outdated or difficult to use Staff training takes too long Limited workflow automation Limited integrations with other systems Security or access-control concerns Current software is too expensive Poor customer support OtherWhich areas would you most like to improve with Compass Pro? Appointment scheduling Patient records and documentation Dental clinical workflows Orthodontic treatment workflows Billing and payments Insurance processes Patient communication Documents and electronic signatures Imaging and X-ray workflows Reporting and analytics Multi-location management Team coordination Workflow automation Data security and user permissions OtherWhich Compass Pro capabilities are most important to your practice? Appointment Scheduling Patient Management and Records Dental Treatment Workflows Orthodontic Treatment Workflows Billing and Payments Insurance Claims and Transactions Patient Communication Documents and eSignatures Imaging and X-Ray Management Reporting and Analytics Patient Portal Multi-Location Management Task and Workflow Automation Compass Pro AI Assistant OtherWhat would make the Pilot Program successful for your practice?Are there any essential systems, devices, or integrations your practice relies on? Yes No UnsurePreviousNextStep 3: Pilot ReadinessSome description about this sectionPreviousNextStep 4: Additional Information and ConsentSome description about this section Previous Submit Form
