"Good morning/afternoon. Thank you for calling Alamo Maxillofacial Surgical Associates. This is         . I can help you!"

"Thanks again for calling. My name is             , and yours is ?"

"I.am happy to help. Tell me, how did you hear about us? Which of our doctors were you referred to?" Notes:

Great! You're calling about                                                  today, and I know we can help you with that. Please, tall me a little more about what is going on.

Are you having any pain or

problems?                                                                                                                                            

I'm glad you called us today. I know Dr.                can help you with             The next step.is for you to coms in and talk with Dr.      about this. Would

            or             work better for you?

I want to make sure you have great experience in our office. I would like to ask a few quick questions. Is that alright?”

"Do you have any dental insurance benefits you would  like to take ad\vantage

of?"

InsCo                                   ID/SS#                                         

In's

Ph#                                                  Employer                                  Grp#                      

Insured name/DOB                                                                                   Patient name/DOB                                                                                                 Ins claims address                                                                                                       

C (Concern): Are there any other concerns or interests related to your oral health that you would like to discuss with the doctor during your visit? (ie:. tooth replacement, other areas of

concern)                                                                                                                           

PI (primary interest) "I want to make sure we take the best care of you when you come in. What is your biggest concern about coming to see us? ( (everyone has different priorities, ie; no waiting, anxiety & fear, insurance, etc) )

Orient & Commit: Thank you for that. OU.                (name) we are looking forward .to seeing you on                for your consultation. You wilt be seeing Dr.

              . .Ha will take any necessary x-rays and evaluate you for              . For

.all your concerns and needs, Dr.   is a great listener, and wilt be able to answer all your questions and decide on the best action to take. Does that make sense?

We to.o.request.that.you.complete.your.patient.registration.online. through,our,webeite.www¡afamooms¡com?.click.on.patIertt.forms¡..Wi\l.   you6e.s6la.to.do.thatahead.of.yout.appointment’?

Again, my name is          _, we are looking forward to seeing you on.

(day/date/ time /location).. Will you be hare? Great,. we will see you then.

SUMMARY

Patient Name

How did you hear about our office?

Pain? Y               N Duration?                               

Special Health Concerns:                                                                                        

Roadblocks:

 Time __Money__ Fear

Xrays? Y N    

Patient address:                                                                                        

Patient ph#                                                                                         

Patient

email                                                                                        Team member's name                                                                                                                                                                                  Referral info                                                                                          

Other Notes                                                          ____________________________________________________________