Marketing + Patients For Life Products



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Marketing + Patients For Life Products PRICES VALID FOR 2015 Prices subject to change without notice

Signature Payment is due in full at the time of treatment unless prior arrangements have been approved. The practice may receive financial remuneration in exchange for making the marketing communication from or on behalf of the third party whose product or service is being described. Date Signature Date Our office is HIPAA compliant and committed to meeting or exceeding the standards of infection control mandated by OSHA, the CDC, and the ADA. Patients for Life Forms, cards, in-office, and follow-up items Patient Feedback Patient Smile and Agreement Patient Feedback Assessment Patient History Medical History Patient Profile The benefits of a happy, healthy smile are immeasurable. Our goal is to help you reach and maintain maximum oral health. Please fill out this form completely. The better we communicate, the better we can care for you. Patient Information Medical History Primary Insurance Coverage Do you have a primary physician? Yes No Date Dental Coverage Yes No Physician s Name Name Insurance Name Please list any serious medical condition(s) that you have ever had: Phone # Email Address Date of last visit? I prefer to be called Male Female Are you currently under the care of a physician? Yes Birthday No Age SS # Phone Are you allergic to any of the following? Please explain: Home Address Group or Policy # We believe in and strive to provide a convenient location with ample parking and expect our staff to always be professional, courteous, and helpful. Aspirin Jewelry Penicillin Insured s Name So that we can provide you with the highest level of service, please Your rate current your experience physical health of the is: following Good areas: Fair Poor Single Divorced Anesthetics Separated Latex Tetracycline Relation It is our goal to offer solutions that are in alignment with what is most important to you. Your smile is an important Are you aspect taking of your any prescription/over-the-counter appearance and how or herbal Erythromycin Metals Sulfa you present yourself. Location and accessibility: Excellent Average Poor Convenience of appointment times: Excellent Married Average Poor Widowed Partner Insured s Birthdate Insured s ID # supplement drugs? Yes No Home Phone # Please list any other drugs/materials Cell # you are allergic to: Insured s Employer The questions below will help you honestly analyze Adequate your parking: smile and determine what type Excellent of dental care Average you desire. Please Poor We list: invite Clean you to and look welcoming in a mirror, environment: smile Excellent Average Poor Work Phone # Extension wide, and answer the following questions: Friendly greeting: Excellent Average Poor Employer Do you have or have you ever had any of the following? Secondary Insurance Coverage What do you want most for your mouth, your teeth, and your smile? Have you ever taken Fosamax or any other bisphosphonate? What can we do to make your next visit more comfortable? Employer Address Frequent, heavy snoring Yes No Yes No Dental Coverage Yes No Significant daytime drowsiness Yes No How long there? Occupation For women: Are you using a prescribed method of birth control? Insurance Name Tendency to stop breathing while sleeping Yes No What do you notice about your teeth/smile when you look in the mirror or when you look at a photograph? Yes No Best time to reach you? Shortness of breath when waking up Yes Address No Are you pregnant? Whom may we thank for referring you? Payment Not feeling refreshed in the morning after sleep Yes No Yes, week # No Other family member(s) seen by us? Morning headaches Yes Phone No I understand that the information I have given today is correct to Are the you best nursing? of my knowledge. Yes I also understand No that this information Present/previous will be held in dentist? the Group or Policy # strictest confidence, and it is my responsibility to inform this office of any changes in my medical status. I authorize the dental staff to perform any Do you like the way your teeth look? Yes No Do you wish your teeth were brighter Have you or whiter? ever had any of the Yes following Nodiseases or medical problems? Date of last visit? necessary dental services that I may need during diagnosis and treatment with my informed consent. Dental History Insured s Name Do you have spaces between your teeth that you Do you have any teeth that are crooked, would like to see closed? Yes No misaligned, crowded, or uneven? Abnormal bleeding Yes No Herpes/fever blisters Why have you come to the dentist today? Relation Spouse Information Alcohol/drug abuse Do you have silver fillings that you wish Would you like your teeth to be straighter? Yes No High blood pressure Insured s Birthdate Insured s ID # were tooth-colored? Yes No Anemia HIV/AIDS Name Do you have any dental crowns or bridges that look Do you need antibiotics before dental treatment? Yes Insured s No Employer Are your teeth chipped? Yes No dark at the edge of your gums? Arthritis Yes No Hospitalization Employer Are you currently in pain? Yes No Artificial bones/joints/valves Kidney problems Are your teeth wearing on the biting surfaces, Insurance Are your gums puffy, red, or tender? Yes No Email Asthma Do your gums ever bleed? Yes Other No Insurance Coverage or worn down from grinding? Yes No Liver disease Do your gums show too much when you Blood smile? transfusion Yes No Birthday Have Age you ever had a serious/difficult SS # problem Do you ever feel a better smile would give you If this office accepts insurance, I understand that I am responsible for payment of service rendered and also responsible Low blood for pressure paying any copayment and Do you have a Health Savings Account (HSA) or Do you ever feel self-conscious about your teeth more confidence? deductible that Yes my insurance No does not cover. I authorize the insurance Cancer/chemotherapy associated with any previous dental work? Yes No payment to be made directly to this office. Mitral valve prolapse Work Phone # Extension FLEX spending account? when you smile or laugh? Colitis Yes No Do you now or have you ever experienced pain Is it important to you to look younger? Yes No Osteoporosis/osteopenia Yes No Do you ever find yourself covering your Congenital mouth heart defect discomfort in your jaw joint (TMJ/TMD)? Yes No Are you interested in avoiding conventional when you laugh or smile? Diabetes Yes No Pacemaker Account Information Your current dental health is: Good Fair If Poor yes, please provide information: dentures and keeping your natural teeth for life? Yes No Psychiatric treatment Do you avoid smiling when you have your Difficulty breathing Do you have difficulty eating, chewing, or drinking? Yes No picture taken? Emphysema Yes No Radiation treatment Person Responsible Are you happy with your teeth? Yes No Are your teeth too long or too short? Yes No Has anyone (family member, friend, etc.) Epilepsy ever Rheumatic/scarlet Relation If not, please tell us why: fever SS # Office Use Only suggested that you should have something Fainting done spells Seizures Billing Address Do any of your teeth appear to be too big or too small? Yes No with your teeth or smile? Yes No Are you missing any teeth? If so, are you interested I verbally reviewed the medical/dental information above with the patient Frequent named headaches Shingles Would you like whiter teeth? Yes Emergency No Contact herein. Initials Date Employer Do you wish you had a new smile? Glaucoma Yes No Sickle-cell disease/traits in replacing them? Yes No How many times a week do you floss? Work Phone # Extension In the event of an emergency, is there someone who lives near you that Doctor s comments: Hay fever Sinus problems Are you interested in cosmetic dentistry? Yes No How many times a week do you brush? we should contact? Heart attack Stroke Email Do any of your teeth appear to be yellow, Heart murmur Thyroid problems Is there anything you have ever wished to be Yes Name No Relation discolored, or stained? Yes No different about your teeth, mouth, or smile? Heart surgery Tuberculosis (TB) Physician Phone # Medical History Update Hemophilia Ulcers If so, please describe: Hepatitis Venereal disease Do any of the following concern you when it 1 comes Date to dental care? Comments Signature Do you use an electric toothbrush? Yes No Fear of dental treatment Amount 2 Date of time required Comments away from work Financial concerns Do you smoke or use tobacco in any form? Yes No Signature Distance to office Not understanding benefits or risks of treatment Embarrassment about condition of teeth 3 Date Comments Signature Other? COMPLIMENTARY Teeth Whitening For Referring and New Patients With new patient cleaning, exam, and necessary x-rays. Receive a $ 25Gift Card For Referring and New Patients With new-patient cleaning, exam, and necessary Dynamic Dental www.dynamicdental.com IT S TIME FOR YOUR NEXT DENTAL HEALTH VISIT CALL US TODAY 123.456.7890 1234 Street Ave, Ste 5 City, ST 12345 We re sending this friendly reminder because our records indicate you are due for your next dental appointment. Regular cleaning visits are essential to detect the early stages of tooth decay and to ensure you re on the right track for a lifetime of healthy teeth. Please phone the office at 123.456.7890 to make an appointment. We love taking care of you and your smile! WHITENING AT YOUR NEXT VISIT Sedation Dentistry COMPLIMENTARY PLEASE BRING THIS POSTCARD AT YOUR NEXT APPOINTMENT. OFFER EXPIRES MONTH/DAY/YEAR. Dental Implants 123.456.7890 DentalWebsite.com Sleep Apnea thank thank you you To: 1234 Street Ave, Ste 5 City, ST 12345 View this catalog of Patients for Life materials on: StratusDentalCreative.com Password: Stratus! Contact your Stratus Marketing Coordinator or Marketing Manager to place an order. Patient Intake Form Gather all pertinent data on this high-quality form, including patient information, insurance coverage, medical history, dental history, payment agreement, patient feedback, and patient smile assessment. There are two versions of the form, one with a HIPAA statement and one without. If your practice does coop marketing with a supplier and you anticipate wanting to advertise to your entire patient database using coop funds, you are required to have an acknowledgment form signed; please order the HIPAA-statement version of the Patient Intake Form that has been customized for this purpose. 8 ½" x 11 Custom Thank You Cards Show your gratitude for customer loyalty and cultivate longterm relationships with patients using these distinctly designed thank you cards and envelopes. To customize, add your logo, brand colors, and a personal note. Blank envelopes are included, or you can choose to have a custom-printed envelope created with your logo and return address. Cards fold to be 4 ¼" x 6 Patient Acquisition Card Your existing patients are your best means for generating new patients. Ask every patient to refer their friends or family members, and give them thanks when they do, through a formalized referral system. Each double-sided card is printed on high-quality plastic material so it presents like a gift card, and it is customized to your practice and offer. Refer to state regulations when selecting an offer. 3 3/8" x 2 1/4" Recare Cards Designed to support your recare program, these cards are mailed to patients as a reminder to schedule their visits and are customized to fit your practice brand. 9" x 6 Recare and Reactivation Letters Stay in touch with your valued patients with these customized letters designed to fit into your patient-retention efforts through recare and reactivation programs. 8 ½" x 11 PATIENTS FOR SNAAP Pads These double-sided pages are designed to help front office staff focus on the five points of communication (the SNAAP Method), ask key questions, and gather insurance information while booking the appointment. 100 sheets per pad. 5 ½" x 8 ½ 2

Marketing Through the Patient Life Cycle Marketing Through the Patient Life Cycle Each stage is built to support your practice s brand A balanced approach to differentiating your brand. As a Member of Stratus Dental Group, you have one of the largest full-time creative agencies in the dental arena working to build and support your practice s unique brand. Visibility Practice Name Brand Architecture Logo Exterior Signage Window Decals and Banners Blogging PR Campaigns Networking Speaking and Sponsorship Events Practice Photos and Videos Advertising Marketing Plan Website SEO Paid Search Direct Mail Newspaper and Magazine Broadcast Directories Outdoor Phone Call PRISM On-Hold Messaging Answering Service Outbound Calling In-Office Experience Patient Reminder System Brand Presence Reception and Operatory Environment Amenities Loyalty Programs Surveys Recall and Reactivation Word of Mouth Patient Acquisition System Social Media Online Reviews Quarterly E-Newsletters Patient Appreciation Physician/Business Outreach Contact your Stratus Marketing Manager with any questions. 3

Business Collateral Customizable items for branding your practice John Smith, DDS jsmith@dynamicdental.com P: 123.456.7890 F: 123.456.7890 www.dynamcidental.com John Smith, DDS jsmith@dynamicdental.com Business Cards Add your branding to this stylishly designed template and make a good first impression every time. Business cards, which are printed in matte unless otherwise requested, have a protective coating over the printed areas and can be printed single or double sided. P: 123.456.7890 F: 123.456.7890 www.dynamcidental.com Horizontal: 3 ½" x 2 Vertical: 2" x 3 ½ You Have an Appointment MON TUE WED THU FRI AM Time: PM Date: www.dynamcidental.com Thank You! Appointment Cards Stop missed and late appointments and improve your time management with these high-quality reminder cards. Customize with your branding, and your patients will think of you every time they smile. Horizontal: 3 ½" x 2 Vertical: 2" x 3 ½ Dynamic Dental www.dynamicdental.com Window Optional John Smith, DDS P: 123.456.7890 F: 123.456.7890 www.dynamicdental.com Letterhead Beautifully designed letterhead adds to your practice s credibility and increases brand awareness with both potential and current patients. This template is smartly designed so that you can showcase your branding in full color and add your logo and practice information. Printed on premium 70# opaque paper stock. 8 ½" x 11 Our Promise Officia net quibus eum et fugia quisaccuptati quam labores exceariae re numet harchit eat dem eosa prem dicaest et est, seque etur, non rectusdae nihit eveliti commoditae nullupt atibus molorehendis quo quis arcit ut aut alique porem faccat quiscipis sequia nobis autasin ciistio quam nempore rspero te coraturi Modi dolorae veleniet eum harion nitat ut enistis id que nimuscitiat assi sunt re dit lacia que nus, quia qui dunt volut molectorecto mo expelen daeratum que prat laut anim dolore parum int quidel iusdam unducienihit essequi beatusa ndaerum, ea nonseque plabore hentur? Mo expelen daeratum que prat laut anim dolore parum int quidel iusdam unducienihit essequi beatusa ndaerum, ea nonseque plabore hentur. Serving Your Dental Needs Cosmetic dentistry Smile makeover Esthetic full-smile/full-mouth rehabilitation CEREC same-day crowns Venners and laminates Teeth Whitening Meet Dr. xproviderx Invisalign Mus maximaximi, quis verspernatus mi, tem incid quaes modio ilias dus maiorrum quiate volo ium inimperumeni cus del mi, tent fuga. Ihita conse reperibus, sequam aut que dolor sam sus ex et veniatis dolut eum rem quamet pelestr umquia quae dit hitius dit, asit voluptas in num si cuptas in expeditis endanditio te ped et lit officiis a quas et untur autaessitiam quam, unt, tempe core, cum eictas ium ni dundi cone vel in nosandunt, optas pe sa core dolupti a enti conet, con prera dolores equistium doluptiatem. Ut modit, tenihilliqui torerit iur, ut apellore nem rera doloreni ut et volut qui rerchil maximpe diaturio ent aliquo dest esto erferfe rspitatiis voloribusam, es excea quis sitium nus doluptae landus ea nia endamus cimaios mosam eos dollut et hicia eatisse quatur, nullupt atemporest que vel etur aut es doluptasiti conse mo everferio occabore laccus magnist, Insurance Veles eatiatur autemqui omnis sint id et ad mi, nem ellatenia dolor repta venti consend aecaecus volupta volest, aboreperatem quisquis ad maximetur adi alicit. Payment Options Et eatectu sandand eribus, sim esti quasimus, ommolup tatisin ullabo. Vita quo eos doles nus saestis dolute nonse net estiunti tem deles modisitiur, quibusa ntincias quiaspe ribus, te pra pratiaerume doluptas prehentem imus, cumquassit velias eici suntius. It, utemperem vitius autempe nes ea impora que alis voluptatquae nulparchit plis ut ipis nihi. Other Services Dental implants Tooth-colored fillings Root canal treatment CEREC same-day ceramic inlays and onlays Snoring and sleep apnea appliances IV sedation/nitrous oxide sedation TMJ treatment Saliva DNA testing Regular dental hygiene Night guards and sports guards Dentures supported by implants Teeth in a day Teeth extractions and socket grafting Periodontal surgery Implant-supported crowns and bridges Digital x-rays Zeiss surgical operating microscopes for minimally invasive treatment Dental sleep medicine Call us today to schedule your appointment! XXX.XXX.XXXX 1234 Street Ave, Unit 5 Some City, ST 12345 xxwebsitewebsite.com How we care for our community Envelopes Make sure your correspondence gets noticed when it arrives in the mail. Customize this envelope template with your logo and branding so that when paired with matching letterhead your communication materials look cohesive and complete! #10 commercial: 4 1/8" x 9 ½" #10 commercial with window: 4 1/8" x 9 ½" Practice Brochures Your logo, branding, and personal business messaging, combined with this professionally designed handout piece, allow you to tell your practice s story while connecting directly and effectively with your target market. Trifold brochure folds to 8 ½" x 3 2/3" Benefits You ll Smile About Extended monthly payment options for restorative & cosmetic treatment Unique. Attentive. Experienced. Excellent care for all patients and families based on their individual needs Leading-edge technology and state-of-the-art facilities Need treatment today? Absolutely. You re free from waiting periods. Deductible free, exclusion free, and no claims to file Flexible Financing Available* *Subject to credit approval Prevention is the most effective way to achieve great oral health. This means practicing good home dental care and seeing a professional twice a year for regular teeth cleanings and x-rays. Preventive care not only protects oral health, it also saves money. Studies indicate that periodontal disease, or gum disease, affects as much as 75% of the U.S. population. Although some forms of gum disease are reversible, most cases require more intervention once they ve reached later stages. This illustrates the importance of preventative oral maintenance: proactive health care prevents serious problems. We hope you ll never face a serious oral health problem, but if you do, our dental benefits will protect you from paying the full cost that others would face. Smile Easier. Save Money. We all know how important it is to feel comfortable at the dentist even financially comfortable, especially for those without dental insurance. Just as we can put you at ease mentally during dental procedures, we can also take the pressure off of your bank account, so you can leave with a smile on your face every time. With our plan, visiting our office is less expensive than you think, and far less expensive than our competitors. Our plan offers an average of more than 30% off average prices in the area which is sure to make you and your budget happy. Ready to save and smile? Enrollment is easy. Annual Membership Annual Discounted Savings Plan Rate Individual $429 35% ($320) Individual + Spouse $829 35% ($320) Each Additional $349 35% ($320) Call us today to schedule your appointment! XXX.XXX.XXXX 1234 Street Ave, Unit 5 Some City, ST 12345 xxwebsitewebsite.com Plan Services Exams (2 per person per benefit year) Cleanings This is not an insurance product. (2 per person per benefit year) X-Rays (full mouth/panoramic 1 per person per XX months) Fluoride Treaments (1 per person per benefit year, under age 16) Sealants (under age 16) 15% Off Cosmetic and Restorative Treatments In-Office Dental Plan A dental savings benefit for patients without dental coverage. In-House Dental Plan Brochures Showcase your payment plan with this sharply designed brochure. Your copy and branding will make your practice stand out while sharing important information with your patients. Trifold brochure folds to 8 ½" x 3 2/3" Ask about our flexible payment options during your next visit, or contact us at XXX.XXX.XXXX for more comprehensive information. 4

Business Collateral/Office Presentation Items Price sheet Name/Description Item # Qty Price ($) Practice Brochure BRO001 500 305 1,000 340 2,000 450 In-House Dental Plan Brochure BRO002 500 305 1,000 340 2,000 450 Business Cards BAC404 500 30 1,000 40 Appointment Cards BAC405 500 30 1,000 40 Letterhead LET242 500 140 1,000 160 #10 Envelopes ENV242 500 240 1,000 300 #10 Envelopes - Window WEN242 500 215 1,000 245 Patient Acquisition Cards PAC001 1,000 440 Patient Intake Forms PFO001 100 60 Patient Intake Forms - Double Sided 100 95 Thank You Cards TYC001 250 180 500 210 1,000 275 Thank You Envelopes (A6) TYE001 250 210 500 230 1,000 270 Recare Postcards REC001 500 135 1,000 165 SNAPP Pad PFO002 1 5 5

Design, Production, and Shipping Times Timelines and standards have been employed to guarantee that adequate development time is devoted to all projects, including quality control, production, and delivery processes. If you have any questions regarding these processes, please speak with your Marketing Coordinator or Marketing Manager. Item Design: First Proof Design: Each Round of Edits Estimated Production and Ordering Estimated Delivery/Shipping Direct Response: newspaper, magazine, and directory ads; newspaper inserts; direct mail (Complete specs and direction must be received at time of order.) 5 business days 3 business days Varies with request Varies with request Writing/Proofing Assistance 5 business days 3 business days n/a Within 24 hours* Business Collateral: business cards, letterhead, envelopes, signage, and practice brochures 7 business days 3 business days 5 business days* 5 7 days** Custom Request 7 business days 3 business days Varies with request Varies with request Logo Design 9 business days 3 business days n/a Within 24 hours* *After final Member approval of proof. **Standard shipping is UPS Ground. Expedited shipping available at an additional cost. 6

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