OMS Setup Questions
2. Form choice
What forms would you like to use? Keep in mind your original order specified an online registration form, an online referral form, or both.
You can choose to utilize either PBHS standard forms, or your own custom forms you currently use in the office.
If you would like to utilize our PBHS standard OMS forms, you may choose from the examples below:
--Standard OMS patient registration/health history link:
Form to be submitted (patients will fill out this HTML form from your website)
https://mysecurepractice.com/Truform/b20a56e0-a9ee-4720-af58-7ed23dc4820a/Submission/Create
Submitted PDF (Information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/reg/formoms.pdf
--Standard OMS doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/507cba96-d4c8-4aba-848a-38ac8e23a6f0/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral.pdf
If you would like to utilize your own custom office forms, you may upload them below. If more pages are sent in than your original order included, we will send you an additional proposal ($150/page).
Please note: If you choose to send us custom forms, the next step is a separately emailed "design confirmation" for you to fax back approval to program your custom forms into our truForm system "as-is" and further modifications are billable.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time.
If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
Endo Setup Questions
2. Form choice
What forms would you like to use? Keep in mind your original order specified an online registration form, an online referral form, or both.
You can choose to utilize either PBHS standard forms, or your own custom forms you currently use in the office.
If you would like to utilize our PBHS standard Endo forms, you may choose from the examples below:
--Standard Endodontics patient registration/health history link:
Form to be submitted (patients will fill out this HTML form from your website)
https://mysecurepractice.com/Truform/15c60c1b-c33c-4007-a933-0da9e068c0b0/Submission/Create
Submitted PDF (Information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/reg/endoperio_form.pdf
--Standard Endo doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/9fffe7f2-113e-4499-9289-9a0cd2b35c63/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral_endo.pdf
If you would like to utilize your own custom office forms, you may upload them below. If more pages are sent in than your original order included, we will send you an additional proposal ($150/page).
Please note: If you choose to send us custom forms, the next step is a separately emailed "design confirmation" for you to fax back approval to program your custom forms into our truForm system "as-is" and further modifications are billable.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time.
If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
Perio Setup Questions
2. Form choice
What forms would you like to use? Keep in mind your original order specified an online registration form, an online referral form, or both.
You can choose to utilize either PBHS standard forms, or your own custom forms you currently use in the office.
If you would like to utilize our PBHS standard Perio forms, you may choose from the examples below:
--Standard Perio patient registration/health history link:
Form to be submitted (patients will fill out this HTML form from your website)
https://mysecurepractice.com/Truform/e2d9ada2-eeb4-47a4-886a-170b4b7ef59d/Submission/Create
Submitted PDF (Information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/reg/endoperio_form.pdf
--Standard Perio doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/46893b7d-e244-4fa7-919b-6ee8a4079788/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral_perio.pdf
If you would like to utilize your own custom office forms, you may upload them below. If more pages are sent in than your original order included, we will send you an additional proposal ($150/page).
Please note: If you choose to send us custom forms, the next step is a separately emailed "design confirmation" for you to fax back approval to program your custom forms into our truForm system "as-is" and further modifications are billable.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time.
If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
General Dentistry Setup Questions
2. Form choice
What forms would you like to use? Keep in mind your original order specified an online registration form, an online referral form, or both.
You can choose to utilize either PBHS standard forms, or your own custom forms you currently use in the office.
If you would like to utilize our PBHS standard General Dentistry forms, you may choose from the examples below:
--Standard General Dentistry patient registration/health history link:
Form to be submitted (patients will fill out this HTML form from your website)
https://mysecurepractice.com/Truform/1f424040-159b-49e0-a41a-30508e8b8ba9/Submission/Create
Submitted PDF (Information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/reg/dent_form.pdf
If you purchased an online doctor referral, you may choose from the following "specialist" standard doctor referral forms.
--Standard OMS doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/507cba96-d4c8-4aba-848a-38ac8e23a6f0/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral.pdf
--Standard Endo doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/9fffe7f2-113e-4499-9289-9a0cd2b35c63/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral_endo.pdf
--Standard Perio doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/46893b7d-e244-4fa7-919b-6ee8a4079788/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral_perio.pdf
If you would like to utilize your own custom office forms, you may upload them below. If more pages are sent in than your original order included, we will send you an additional proposal ($150/page).
Please note: If you choose to send us custom forms, the next step is a separately emailed "design confirmation" for you to fax back approval to program your custom forms into our truForm system "as-is" and further modifications are billable.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time.
If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
Orthodontics Setup Questions
2. Form choice
What forms would you like to use? Keep in mind your original order specified an online registration form, an online referral form, or both.
You can choose to utilize either PBHS standard forms, or your own custom forms you currently use in the office.
If you would like to utilize our PBHS standard Orthodontics forms, you may choose from the examples below:
--Standard Orthodontics patient registration/health history link:
Form to be submitted (patients will fill out this HTML form from your website)
https://mysecurepractice.com/Truform/65250dd5-75cf-418b-a47b-baf1bd066085/Submission/Create
Submitted PDF (Information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/reg/dent_form.pdf
If you purchased an online doctor referral, you may choose from the following "specialist" standard doctor referral forms.
--Standard Orthodontics doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/9a12dd27-c416-4258-b561-85407324a994/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/orth_ref.pdf
If you would like to utilize your own custom office forms, you may upload them below. If more pages are sent in than your original order included, we will send you an additional proposal ($150/page).
Please note: If you choose to send us custom forms, the next step is a separately emailed "design confirmation" for you to fax back approval to program your custom forms into our truForm system "as-is" and further modifications are billable.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time.
If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
Prosthodontics Setup Questions
2. Form choice
What forms would you like to use? Keep in mind your original order specified an online registration form, an online referral form, or both.
You can choose to utilize either PBHS standard forms, or your own custom forms you currently use in the office.
If you would like to utilize our PBHS standard Prosthodontics forms, you may choose from the examples below:
--Standard Prosthodontics patient registration/health history link:
Form to be submitted (patients will fill out this HTML form from your website)
https://mysecurepractice.com/Truform/006173c3-1c53-46e0-9f20-bfad9e502d17/Submission/Create
Submitted PDF (Information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/reg/dent_form.pdf
If you purchased an online doctor referral, you may choose from the following "specialist" standard doctor referral forms.
--Standard Prosthodontics doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/3de495af-3afd-434a-861f-4b13ded5166a/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral.pdf
If you would like to utilize your own custom office forms, you may upload them below. If more pages are sent in than your original order included, we will send you an additional proposal ($150/page).
Please note: If you choose to send us custom forms, the next step is a separately emailed "design confirmation" for you to fax back approval to program your custom forms into our truForm system "as-is" and further modifications are billable.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time.
If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
Pediatric Setup Questions
2. Form choice
What forms would you like to use? Keep in mind your original order specified an online registration form, an online referral form, or both.
You can choose to utilize either PBHS standard forms, or your own custom forms you currently use in the office.
If you would like to utilize our PBHS standard Prosthodontics forms, you may choose from the examples below:
--Standard Pediatric patient registration/health history link:
Form to be submitted (patients will fill out this HTML form from your website)
https://mysecurepractice.com/Truform/006173c3-1c53-46e0-9f20-bfad9e502d17/Submission/Create
Submitted PDF (Information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/reg/dent_form.pdf
If you purchased an online doctor referral, you may choose from the following "specialist" standard doctor referral forms.
--Standard Pediatric doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/507cba96-d4c8-4aba-848a-38ac8e23a6f0/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral.pdf
If you would like to utilize your own custom office forms, you may upload them below. If more pages are sent in than your original order included, we will send you an additional proposal ($150/page).
Please note: If you choose to send us custom forms, the next step is a separately emailed "design confirmation" for you to fax back approval to program your custom forms into our truForm system "as-is" and further modifications are billable.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time.
If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
Other Specialty Setup Questions
2. Form choice
What forms would you like to use? Keep in mind your original order specified an online registration form, an online referral form, or both.
You can choose to utilize either PBHS standard forms, or your own custom forms you currently use in the office.
If you would like to utilize our PBHS standard forms, you may choose from the examples below:
--Standard General Dentistry patient registration/health history link:
Form to be submitted (patients will fill out this HTML form from your website)
https://mysecurepractice.com/Truform/1f424040-159b-49e0-a41a-30508e8b8ba9/Submission/Create
Submitted PDF (Information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/reg/dent_form.pdf
--Standard OMS patient registration/health history link:
Form to be submitted (patients will fill out this HTML form from your website)
https://www.mypbhs.com/truform/html/index.html?form=demo/main/reg/form.pdf&location=inOffice&showSignature=true
Submitted PDF (Information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/reg/form.pdf
If you purchased an online doctor referral, you may choose from the following "specialist" standard doctor referral forms.
--Standard OMS doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/507cba96-d4c8-4aba-848a-38ac8e23a6f0/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral.pdf
--Standard Endo doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/9fffe7f2-113e-4499-9289-9a0cd2b35c63/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral_endo.pdf
--Standard Perio doctor referral form link:
Form to be submitted (patients will fill out this HTML form from your website):
https://mysecurepractice.com/Truform/46893b7d-e244-4fa7-919b-6ee8a4079788/Submission/Create
Submitted Form (information submitted above will print on the below PDF for review):
https://www.mypbhs.com/truform/forms/pbhs/main/ref/referral_perio.pdf
If you would like to utilize your own custom office forms, you may upload them below. If more pages are sent in than your original order included, we will send you an additional proposal ($150/page).
Please note: If you choose to send us custom forms, the next step is a separately emailed "design confirmation" for you to fax back approval to program your custom forms into our truForm system "as-is" and further modifications are billable.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time.
If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
We will need your personal form in either a word document or a PDF form ONLY. We do not accept scanned forms at this time. If a professional printer created your forms, they can send the original electronic file to you as a PDF document.
Please include any special notes regarding your truForm order below.