Welcome back. We've already filled in a few details we had on file, so you have less to type. Please review them as you go.
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If your practice trades under a different name, enter the full registered name here. If it's the same as your practice name above, just repeat it. This is the name used on your legal agreements.
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This is how your clinic name appears in patient email inboxes.
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The email address patient replies will go to.
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If your office uses specific wording for patient communications, note it here. Leave blank to use standard AirwayZ language.
Hours vary by day? This data is used to time patient emails - just enter the days and hours when you want patient emails going out. It doesn't need to reflect every operational hour your office is open.
Please select at least one day.
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Please upload your clinic logo.
1. Click Sample from Logo next to either color field below
2. Your logo will appear above with a crosshair cursor
3. Click on any color in your logo to capture its exact hex code
4. The color preview will update instantly
Choose two colors that represent your clinic. Both colors must be dark enough that white text is readable on top of them. Test your colors at webaim.org/resources/contrastchecker - you need a minimum ratio of 4.5:1 with white text.
Used for headers and backgrounds. Should be your darkest brand color - navy, deep teal, charcoal, etc.
Used for buttons and accents. Should be a medium tone, noticeably different from your primary color.
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The exact name of the appointment type in your scheduling system that should trigger the AirwayZ education workflow.
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Patient email is required for the AirwayZ platform to function. All patient communication is delivered via email.
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Who at your practice is authorized to approve third-party integrations with your scheduling system?
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If you want each user to have a unique login, we need a unique email address for each, since it will be the username. If the same email address is used more than once, only one login will be created for that email address.
We will create the login accounts and the login information will be sent to these people only (to the email addresses you list below), to ensure the privacy of your patient information.
These are your portal logins. Each person listed here gets their own access to the AirwayZ portal. This is separate from your onboarding contact, though they are usually included here too. We've added you as the first staff member so you'll have access, please confirm your details and your role, then add the rest of your team.
Numbers only. 4 digits. Choose something easy for staff to remember but not obvious (avoid 1234, 0000).
Please enter exactly 4 digits.
PINs do not match.
This is the person who will sign the Provider Agreement and BAA on behalf of the practice. They must have the authority to sign, typically the practice owner or an authorized administrator. This may or may not be you.
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The agreement to sign will be sent to this email address.
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These details appear on your legal agreements, so we fill them in for you and your signer simply signs. Enter them for the practice and the provider who signs.
The state your practice entity is legally registered/incorporated in.
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The named licensed provider on the agreement (usually the signer).
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All states the provider is licensed in. Separate with commas.
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Questions? Email us at [email protected]