Oral Health First — Practice Onboarding & Signature

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Step 1 · Practice

Practice details

These required details identify the office and populate the agreement.

Practice Identity

Practice name Legal business name Use the name shown on the practice tax return.

Primary Location

Street address

City

State ZIP

Number of locations Practice type

How Is the Practice Owned?

Independent Group Equity DSO

Step 2 · People

Authorized Signer

These details appear on the agreement.

Authorized Signer

Signer legal name

Job title Signing capacity

Email Office phone

Day-to-Day Contact Optional

Day-to-Day Contact

Add this only when someone other than the signer should be the main contact.

First name Last name

Email Mobile phone

Step 3 · Operations

Practice operations

Practice profile These answers help OHF understand the office and are not printed on the agreement.

Weekly Workflow

Practice software Optional Other software Typical hours Optional

Days open

Practice at a Glance Optional

Practice at a Glance

Owner dentists Total dentists Hygienists Operatories Total FTEs Active patients

Monthly patient visits Optional Intraoral scanner Optional

Step 4 · Business

Business Profile

Practice profile Every field on this step is optional and stays off the agreement.

Business Profile Optional

Business Profile

Entity type Years in practice

Organization NPI Website

Financial Snapshot Optional

Financial Snapshot

Broad ranges are enough. Choose “Not sure” where available.

Annual Practice Revenue

Under $500K $500K–$999K $1M–$1.99M $2M–$4.99M $5M+

Annual Card Volume

Under $250K $250K–$499K $500K–$999K $1M–$1.99M $2M+

Current Card Processing Fee

Under 2% 2%–2.49% 2.5%–2.99% 3%–3.49% 3.5%+ Not sure

Facility & Plans Optional

Facility & Plans

Primary Facility

LeaseOwn

Considering a Sale or Acquisition in 12–36 Months?

YesNoMaybe

Anticipating Acquiring Another Practice?

YesNo

Step 5 · Services

Services offered

Practice profile Select any that apply, or skip straight to the agreement.

Insurance Accepted Optional

Insurance Accepted

Other insurance

Procedures Offered Optional

Procedures Offered

Other procedures

Next: review your agreement.Your signature and consent are always captured fresh, even when resuming.

Step 6 · Review

Review Your Answers

Check each section and edit anything that needs correcting. Then review your agreement below.

Your agreement

The PDF below is the agreement you will sign. Review every page, including the terms.

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If the preview does not display on your device, open or download it above.

Step 7 · Sign

Sign Your Agreement

Agree to electronic signing, add your signature, then confirm your name.

1Electronic Consent

Read the statement below and select the checkbox to continue to your signature.

2Add Your Signature

Draw with a mouse, trackpad or finger, or use the upload and camera buttons.

Need to start over? Clear the box to draw or choose another image.

3Confirm Your Name

Name on your agreement

Type your legal name to adopt this signature

Type the name shown above, including any middle name or initials. Capitalization doesn't matter.

✓

Step 8 · Complete

Your document is signed.

Your signed document is ready. Download a copy for your records; the last page contains the audit certificate.

Submission ID

Download signed document

Document verification

SHA-256 identifies the exact signed PDF bytes.

Practice onboarding

Practice details

Authorized Signer

Practice operations

Business Profile

Services offered

Review Your Answers

Your agreement

Sign Your Agreement

Your document is signed.

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