Welcome to the PrecisionSmile™ Media

Congratulations — you’re officially one step closer to launching your PrecisionSmile™ Media system.
Our team is excited to partner with your practice to bring more qualified implant and full-arch patients through your doors. To get started, we need a few key details about your practice so we can personalize your campaigns, set up your dashboard, and connect your tracking systems.

Dental Practice Name *

MUST BE EXACTLY AS THE OFFICE NAME SHOULD APPEAR IN ALL MEDIA TYPES (Your exact brand name) For Example - Correct: "Miller Dental of Miami" - Incorrect "Dr. Jeff Miller DDS"

Address

Practice Address

City

State

Postal Code

Office Email *

Office Direct Line *

Why We Need Your EIN and Business Type:
Providing your EIN and business structure (LLC, Corporation, etc.) helps us meet regulatory requirements for SMS communication on your behalf. This ensures smooth, compliant messaging for reminders and outreach.

Business EIN Number *

Business Type *

LLC, Corporation, etc.

Front Office Receptionist

Point of Contact Cell Phone

Practice Website

Doctors Full Names

Doctors Email

Doctors Cell Phone

What are your Hours of Operation?

Lunch Hours (When phones will NOT be answered)

What are the Names, Emails, and Contact Phone Numbers to everyone on your staff that will need to receive an email notifications?

Cross Streets ( to explain your location)

Parking Information

For example, is parking free and where is it located

Nearby Landmarks

Things that help specify where your dental office is located for a new patient traveling to your location (example: large mall, hospital, well known restaurant)

Cost for New Patient Children's Cleaning

Cost for New Patient Adult Cleaning

Cost for New Patient Emergency Exam

Must specify cost and if it includes limited x-ray

Emergency Protocol - How to handle emergency patients who call in outside of business hours

If we get an emergency patient after hours, who should we contact to assist this patient?

Cancellation Protocol

Is there a potential fee for cancellation? Do you request notice? Can DGP accept and complete a cancellation for one of our patients?

Payment Types Accepted

Youngest Age Treated in office

Financing Options Offered

Please be specific. Examples: Care Credit, Lending Tree, In House Financing

Insurances NOT Accepted By the Office

Insurances Accepted By the Office

Who is your target audience for your product (job titles, age, gender, location, stereotypes, interests, demographics)

What cities/zip codes (zip codes work better if you have them) would you like to reach? Please list them all.

Does Your appointment software have an appointment reminder via sms and email set up?

The offer we promote for our clients is "FREE CBCT Scan & consultation ($750 Value)." Is your practice able to offer this deal? If YES, please type YES below. If not please let us know what is your best offer for dental implants.

Do you accept Medicaid Cases?

YES or Other

Do you service or have a hispanic community near you that could be potential patients?

Do you know your brand color codes?

Please provide any links to Media files.

Logos, Videos, Photos, etc

I agree that I have completed the above information CORRECTLY to the best of my ability. *

I agree

Signature *

Clear

From Click To Conversion, In 3 Simple Steps

Targeted Lead Generation

We run proven ad campaigns and direct prospects to high-converting funnels designed for your services.

Instant Response

Our Smile Team calls and texts every lead within minutes — multiple times if needed — to lock in the appointment.

Booked and Ready

We add confirmed appointments directly into your calendar. No chasing. No missed opportunities.