ADA TV Setup Questionnaire - Amazon Fire TV Santa Rosa CA, PBHS

Practice Name:*

Website URL

example: www.mywebsite.com or www.pbhs.com

Contact Phone Number*

Contact E-mail Address*

If PBHS Support has any questions, we would like to use this e-mail to communicate.

Please select your practice specialty:*

Do you want us to include your Launch Survey testimonials?*

(Launch Survey is a paid service provided by PBHS. If you DO NOT currently pay for this service through PBHS, then select any other answer aside from the 'Yes' option below.)

Yes
No
I don't have Launch Survey
I don't have Launch Survey, but would like to be contacted to learn more about this product

Do you want us to include any videos from YouTube?*

Yes
No

Please copy and paste the URLs to the YouTube videos you want to include

Do you want us to link your Facebook page?*

Yes
No
I don't have a Facebook page

Please provide your business Facebook page URL:

Facebook Page Login Email:

Note: If these credentials are not provided or are inaccurate, PBHS will not be able to set up Facebook integration.

Facebook Page Login Password:

Note: If these credentials are not provided or are inaccurate, PBHS will not be able to set up Facebook integration.

The Amazon Fire ADA TV app comes with a news ticker (chyron) that plays at the bottom of the screen and can be customized with different news feeds. Please select all the categories you would like displayed:*

**You can select/deselect the options provided below.

Entertainment News
Financial News
Health News
Sports News
Weather News
None

The Amazon Fire ADA TV app also comes with optional Informational Marketing slides and videos. This content is curated and automatically updated periodically. Which of the following categories would you like included?*

**You can select/deselect the options provided below.

Botox
Clear Correct
Dental Implants (General Implant Overview, Nobel Biocare, Biohorizons and Yomi)
Health (HealthDay | http://www.healthday.com)
Invisalign
Straumann

The Amazon Fire ADA TV app also comes with optional Entertainment YouTube videos. Please select any of the following categories you would like on your device:*

**You can select/deselect the options provided below.

Consult Mode Information

Along with using your ADA TV device(s) within your practices waiting room and/or additional TV's, you can now utilize shorter procedural playlists from a tablet or computer during the patient's chair side consultation using Consult Mode. Click here for further information on using Consult Mode in your practice.

Please select the Consult Mode Playlist(s) you would like:*

With the addition of Consult Mode, PBHS has predesigned the playlists listed below. This includes a combination of silent dental animations and images, which will help increase of case acceptance and patient education during the consultation. Additionally, you can build your own Consult Mode playlists at anytime. **Shared Playlists can be added or removed at anytime. **Shared playlists cannot be modified. Shared Playlists will be auto-updated by PBHS periodically with improved silent animations, slides and video's.

For orders that include multiple offices:

If your office's provide similar procedures and share a common email, please select the checkbox below to apply the above settings for each location. If your locations differ in procedure's offered or email's used, please fill out this questionnaire individually for each location.

Apply settings for all locations

Agreement*

By checking this box you agree this is the content you want added to ADA TV, changes may be billable. The term of contract is 1 year from activation.

Thank you for completing this form. Please click the "Submit" button below.

Initials

This field is for validation purposes and should be left unchanged.

Amazon Fire ADA TV Setup Questionnaire

Amazon Fire ADA TV Setup Questionnaire

Consult Mode Information