Design Partner Intake

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Step 1 of 5

Practice Overview

Basic information about your practice.

Practice Name * Practice name is required.

DBA / Public-Facing Name If different from above

Number of Locations * Required.

Primary Specialty * Please select a specialty.

Practice Management System

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Step 2 of 5

Business Information

Required for A2P 10DLC brand registration with carriers via Twilio. Must match your IRS / state registration exactly.

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Brand registration requires exact legal details. The EIN, legal name, business type, and address must match your official IRS or state business registration. Mismatches will cause carrier rejection.

Legal Entity

Legal Business Name * Exactly as registered with the IRS / state Legal business name is required.

DBA / Public-Facing Name

Business Type * Required.

EIN (Federal Tax ID) * Format: 12-3456789 EIN is required for brand registration.

Business Address * Physical address — no PO boxes Physical address required.

Website URL * Must be live and publicly accessible Valid URL required.

Authorized Contact

Full Name * Required.

Title * Required.

Email Address * Valid email required.

Phone Number * Required.

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Step 3 of 5

Campaign Registration

Use case and compliance details required to register your messaging campaigns with carriers.

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This registers your campaign with The Campaign Registry (TCR). Carriers require a declared use case, opt-in method, and compliance confirmation before your number can send messages. This is not about message content — it's about authorization.

Use Case — What messages will be sent?

Appointment reminders Appointment confirmations Missed call follow-up Scheduling coordination Billing / balance notifications Recall / reactivation

Opt-In / Consent Method

How do patients consent to receive messages from your practice?

Intake forms (paper or digital) Website forms In-office verbal or written agreement

Compliance Acknowledgement

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All four items are required by carriers for campaign approval. Incomplete acknowledgement will block registration.

We only message patients who have provided express written consent We do not use third-party or purchased contact lists All messages include opt-out instructions — Reply STOP to opt out HELP instructions are supported — Reply HELP for assistance

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Step 4 of 5

Technical Setup

PMS access for the Revenue Audit phase. Read-only — nothing is modified in your system.

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Read-only access only. No records are modified. Credentials are stored securely and deleted after the audit validation period is complete.

Database Access

Server / Database Host IP address or hostname

Database Name

Username Read-only account preferred

Password

IT Contact (if applicable)

Name

Email

Phone

Optional (Recommended)

Demo or backup database access Google Business Profile access Phone system / call tracking details

Additional Notes

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Step 5 of 5

Review & Submit

Confirm your information and authorize your Design Partnership.

What Happens Next

① DentOPS team reviews intake and contacts you within 2 business days

② Brand + campaign registration submitted to The Campaign Registry via Twilio

③ PMS integration begins — Revenue Audit delivered end of Week 2

④ AI Voice Front Desk and Revenue Recovery agents go live Weeks 3–4

Anything else we should know?

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Authorization: By submitting this form, you confirm that all information is accurate, you are authorized to represent this practice, and you consent to DentOPS registering your brand and messaging campaigns with carriers on your behalf. A Business Associate Agreement (BAA) will be executed concurrently with your Design Partner Agreement.

Authorized Signature — Full Name * Signature required.

Date

Design Partner
Intake Form

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Design PartnerIntake Form

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Design Partner
Intake Form