Welcome to SearchMyDoc registration
SMD account informationzzzzzzzzz


This form contains all information required to open you account on SearchMyDoc and connect it to your website's "Schedule and Appointment" button. If you would like to have your Search My Doc account connected to your local patient management software (such as Dentrix) please indicate it in the form, and our specialist will help you to go through connection process.

PHOTOS: we strongly suggest adding your photograph to the account. This helps to build trust of a potential patient and to establish friendly personal touch to the appointment process.
Please send all doctor's profile photos to SMDregistration@cloudlions.com

The registration information is brief and takes on average 10 minutes to complete.

GREEN fields are required

Let's Get Started!

Your Practice Details:


Your Fist Name (required):

Your Last Name (required):

Your Practice (Clinic) Name:

 Register as clinic ONLY (the individual doctors' schedules will not show)

Your Email Address - will be a login to your practice (required):

Temporal Password - you can replace it later (required):

Main Phone Number (required):

Medical Specialty:

Practice Description (optional):

Practice website address:

 I need assistance with connecting SMD to local Patient Management

 I need assistance with installing appointment button on my site



First Location Information (required):

Specialties:

 Cosmetic Dentist Dental Pain Specialist Endodontist Oral Surgeon Orthodontist Pediatric Dentist Periodontist Prosthodontist Hygenist

Reasons for Visit:

 Braces Consultation Bridge Crown Dental Cleaning Dental Consultation Dental Emergency Dental Follow Up Dentures Filling Gum Surgery Implant(s) Invisalign Consultation Retainer Installation Root Canal Teeth Whitening Tooth Extraction Veneer(s) Wisdom Tooth Problem

Other:

Location Name (visible for patients):

Location Email - (if different from account email):

Location Phone (if different from main number):

Address (required):

City (required):

State (required):

Zip (required):



Second Location Information (skip if none):

Specialties:

 Cosmetic Dentist Dental Pain Specialist Endodontist Oral Surgeon Orthodontist Pediatric Dentist Periodontist Prosthodontist Hygenist

Reasons for Visit:

 Braces Consultation Bridge Crown Dental Cleaning Dental Consultation Dental Emergency Dental Follow Up Dentures Filling Gum Surgery Implant(s) Invisalign Consultation Retainer Installation Root Canal Teeth Whitening Tooth Extraction Veneer(s) Wisdom Tooth Problem

Other:

Location Name (visible for patients):

Location Email - (if different from account email):

Location Phone (if different from main number):

Address (required):

City (required):

State (required):

Zip (required):





Third Location Information (skip if none):



Specialties:


 Cosmetic Dentist Dental Pain Specialist Endodontist Oral Surgeon Orthodontist Pediatric Dentist Periodontist Prosthodontist Hygenist


Reasons for Visit:

 Braces Consultation Bridge Crown Dental Cleaning Dental Consultation Dental Emergency Dental Follow Up Dentures Filling Gum Surgery Implant(s) Invisalign Consultation Retainer Installation Root Canal Teeth Whitening Tooth Extraction Veneer(s) Wisdom Tooth Problem

Other:

Location Name (visible for patients):

Location Email - (if different from account email):

Location Phone (if different from main number):

Address (required):

City (required):

State (required):

Zip (required):

To add more than three locations - ask us for help



MAIN DOCTOR INFORMATION (required):



First Name:

Last Name:

Professional Suffixes:

Gender:  Male Female

Specialties:  Specialties are same as 1st location

 Cosmetic Dentist Dental Pain Specialist Endodontist Oral Surgeon Orthodontist Pediatric Dentist Periodontist Prosthodontist Hygenist

Reasons for Visit:  Reasons are same as 1st location

 Braces Consultation Bridge Crown Dental Cleaning Dental Consultation Dental Emergency Dental Follow Up Dentures Filling Gum Surgery Implant(s) Invisalign Consultation Retainer Installation Root Canal Teeth Whitening Tooth Extraction Veneer(s) Wisdom Tooth Problem

Other:

Languages Spoken:

SCHEDULE:

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

If no schedule is entered, patient will be prompted to choose any date or time for an appointment.


SECOND DOCTOR INFORMATION (skip if none):



First Name:

Last Name:

Professional Suffixes:

Gender:  Male Female

Specialties:  Specialties are same as 1st location

 Cosmetic Dentist Dental Pain Specialist Endodontist Oral Surgeon Orthodontist Pediatric Dentist Periodontist Prosthodontist Hygenist

Reasons for Visit:  Reasons are same as 1st location

 Braces Consultation Bridge Crown Dental Cleaning Dental Consultation Dental Emergency Dental Follow Up Dentures Filling Gum Surgery Implant(s) Invisalign Consultation Retainer Installation Root Canal Teeth Whitening Tooth Extraction Veneer(s) Wisdom Tooth Problem

Other:

Languages Spoken:

SCHEDULE:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday


If no schedule is entered, patient will be prompted to choose any date or time for an appointment.


THIRD DOCTOR INFORMATION (skip if none):



First Name:

Last Name:

Professional Suffixes:

Gender:  Male Female

Specialties:  Specialties are same as 1st location

 Cosmetic Dentist Dental Pain Specialist Endodontist Oral Surgeon Orthodontist Pediatric Dentist Periodontist Prosthodontist Hygenist

Reasons for Visit:  Reasons are same as 1st location

 Braces Consultation Bridge Crown Dental Cleaning Dental Consultation Dental Emergency Dental Follow Up Dentures Filling Gum Surgery Implant(s) Invisalign Consultation Retainer Installation Root Canal Teeth Whitening Tooth Extraction Veneer(s) Wisdom Tooth Problem

Other:

Languages Spoken:

SCHEDULE:

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

If no schedule is entered, patient will be prompted to choose any date or time for an appointment.

To add more than three doctors - ask us for help



Insurances:

List insurances accepted by your practice
(optional - can be added later):