Step 1 of 2

EFT & ERA one-time set-up fee with Remote Training: $2500

Terms and Conditions

I agree to confidentially regard all information of a proprietary nature which I may encounter in our work with your practice. I will be using consulting methods and materials which are proprietary to my business. You and your staff agree to confidentiality regarding such material, and to restrict its use to the purpose of the engagement.

All remote training sessions will be the responsibility of practice to coordinate with Dental WebSmart Insurance Solutions. A change in my schedule at the last minute can affect many people. If either party must forfeit this scheduled time for any unforeseen reason a time frame of more than a week in advance is appreciated.

General Provisions:

All information is communicated and handled by Dental WebSmart Insurance Solutions, LLC to maintain HIPAA compliance with a signed confidentiality and non-disclosure agreement between both parties.

My client understands his/her full responsibilities in implementing any results, related to our work together. Dental WebSmart Insurance Solutions, LLC hereby states a onetime fee is to be paid in full at start of Set-up, with the option to negotiate any changes.

Any additional work beyond what’s stated will be discussed between both parties, and will be covered by the provisions of this Agreement.

Please sign and return this confirmation with your fee for set-up to my office Fax-805-484-3415. We sincerely look forward to assisting your office in reaching new goals.
Name(Required)
MM slash DD slash YYYY
Dental WebSmart Insurance: Christine Haines (CEO)