Required.
Required.
Required.
Required.
Required.
Required.
Required.
This is how your clinic name appears in patient email inboxes.
Required.
The email address patient replies will go to.
Required.
Required.
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.
Required.
Required.
Required.
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.
Required.
The exact name of the appointment type in your scheduling system that should trigger the AirwayZ education workflow.
Required.
Patient email is required for the AirwayZ platform to function. All patient communication is delivered via email.
Required.
Required.
Who at your practice is authorized to approve third-party integrations with your scheduling system?
Required.
Required.
Required.
We will create their 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.
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 person handles the legal agreements. This is typically the practice owner or an authorized administrator.
Required.
Required.
Required.
Required.
Required.
Required.
Required.
Questions? Email us at [email protected]