Hello and welcome!
The purpose of this survey is to allow The Bridge Network to configure your Tracker software in advance of the software training. It will take about 15-30 minutes to complete. It is strongly advised that the owner of the office or an authorized office manager/employee fill out this survey since it involves some sensitive user rights and options in the software program.
Tracker and The Bridge Network cannot be held responsible for any misuse of the Tracker software as a result of the answers from this survey.

Your Name:
Are you authorized?—Please choose an option—Yes, I am an authorized owner or employee of the office and agree with the above conditions.No, I am not an authorized owner or employee and/or I disagree with the above conditions.
Please select your clinic type: —Please choose an option—Dental, orthodontic, denturist, or hygienist officeChiropody office

Practice/Provider/Security Information

Practice Name:
Office Owner Name:
Main Office Phone Number:
Office Email Address:
Please let us know which of the following digital x-ray equipment you are using (make, model, manufacturer). If you are uncertain please contact your office's technician.
1) digital sensors
2) digital pan
3) intraoral cameras

Please let us know which software you are using to take digital x-rays? Does it integrate with your current practice management software or does it require a bridge connection to external software.
We will create users and assign user rights for each of your staff members based on their role in the office. These rights will be reviewed with your Tracker trainer(s) and can be revised if desired.
Please list your Office Manager(s) and indicate their username.
Please list each Front Desk staff member and indicate their username.
Please list each Dentist, indicate if they are a specialist (ie. Orthodontist, periodontist), and their username.
Please list each Hygienist and indicate their username.
Please list each Dental Assistant and indicate their username.
Please list any other Tracker users you require and their position and username.
Please list all of the practitioners of the practice and include their unique code beside their name. For dental offices it is the 9 digit EDI claims code and for Chiropodists it is the 6 digit College of Chiropody Number
Please enter your 4 digit Office EDI number/code (if you don't have yours yet, please contact the CDA to register):
Please list the provider hours below (if hours vary between providers, this can be completed during training instead - please leave blank):

General Options

Please enter the default city for new patients that are entered into Tracker Note: This option can be changed anytime.
What is the default area code for new patients being entered into Tracker?
Would you like to display months in a patient's age? Eg. John is 29 years and 4 months old.—Please choose an option—YesNo

Insurance Options

Who will be the default payee?—Please choose an option—Office (assignment)SubscriberThird Party
What will be the default insurance form used?—Please choose an option—ADAAHCCDACAODAOCDHAFDSPre De
What is the default Pre-D form?—Please choose an option—ADAAHCCDACAODAOFDSCDHAPre De

Billing Options

What is the default NSF fee?
Would your office like to round off fee prices to the nearest $0.10, nearest $1.00 or use exact fee prices?—Please choose an option—Round to nearest $0.10Round to nearest $1.00Use Exact Fee Prices

Global Schedule Options

Your office's tracker scheduling needs to be configured as per the following items below. Please enter your preferred options:
Default units of time in minutes: (ex. appointment times every 15 minutes)—Please choose an option—5 minutes10 minutes15 minutes20 minutes30 minutes
Earliest Start Time:
Latest End Time:
Default recall interval in months (most offices use 6 months). If using weeks, please specify.
Please list all holidays that your office will be closed for.
Would you like to have double booking columns for each of the providers (practitioners) in Tracker? —Please choose an option—YesNo

Training Related Questions

Please describe the office space where training will take place. Do you have a large screen TV that our trainer can plug a laptop into for training? If not, do you have a plain wall that we can project onto?

I have read The Bridge Network's training policies, procedures and rates and I fully understand the terms stated. Please review the Training Policies and Implementation Package. The link to the document can be found here

Please select:—Please choose an option—Yes, I understand and agree to the training rates, policies and terms.No, I do not understand and/or agree to the training rates, policies and terms.