Welcome to ClinCheckHelp.Net - Dr. Perry Jones

Order Invisalign Consulting Services by Perry Jones, DDS

PLEASE READ THE INSTRUCTIONS BELOW:

After you click on the doctor's button choice below, you will be directed to a form fill-out. Please fill out the form FIRST! Once you submit the form, the page will reload for you to choose from the applicable fee options. All transactions will go through PAYPAL. Your order IS NOT complete until you complete the selection(s) and checkout process through PAYPAL. Dr. Jones will take a look at your case file. Your consultation will start AFTER PayPal payment is received. As a note to submitting Drs, please be sure your patient has signed a HIPAA compliance form BEFORE submitting any information to the consultant.

STEP 1: Doctor's Information


PLEASE READ THIS BEFORE YOU FILL OUT THE FORM!!

  • Please fill out the information below and Dr. Jones will take a look at your case file.
  • MidWest Dental Group: Once you complete, your info will be submitted and we will be in contact with you shortly!
  • As a note to submitting Drs, please be sure your patient has signed a HIPAA compliance form BEFORE submitting any information to the consultant.
  • All fields are required!
Dr's. First Name:
Dr's. Middle Name:
Dr's. Last Name:
Dr's. Email Address:
Address:
 
City:
State:
Zip:
Phone:
   I have read and I understand the Client Service Agreement CONSENT FORM.


STEP 2: Choose Consultation Service


Please note: Your MUST email a photographic template of your patient to perry@drperryjones.com.

 

PSA (Pre-Submission Advice) $50
  • Case Review (Is this a good case?)
  • Approx. length of treatment time
  • Align product type
  • Outline of challenge using Invisilign
CS (Comprehensive Service) $250
  • Case Evaluation
  • Complete Align RX Form
  • Electronic case submission
  • ClinCheck review with modifications
  • Explanation of modifications
CC (ClinCheck Only) $200
  • ClinCheck Review
  • Explanation of Modifications
CCMC (Mid Course Correction/Refinement) $200.00
  • ClinCheck Review
  • Explanation of Modifications


STEP 3: Patient's Information
Patient's First Name:
Patient's Last Name:
Align Username: (min 6 chars)
Align Password: (min 6 chars)
Confirm Password: (min 6 chars)
Notes to Consultant on your patient:
   
   

HOW IT WORKS:

  • The website provides assistance from our independent consultant, Dr. Perry Jones.
  • The consultation services includes the very same PSA and CS that were available from the former ICS.
  • The objective of the Pre-submission advice is to offer Drs. a simple case review to help determine an approximate length of treatment time, Align product type and outline of possible challenges for the case using the Invisalign.
  • The objective of the Comprehensive service is to help Drs. with ClinCheck review and suggested modifications. The CS may also include help with the electronic submission of the appropiate Invisalign Treatment form.
  • The website provides for a Dr. to access a completely separate consultant, Dr. Jones.
  • Payment is via a secure service, PayPal.
  • Our website also provides for direct payment in addition to PayPal.
  • Fees are listed on the website and are less than the former ICS.
  • Drs. are required to "click" on and agree to a consultant disclaimer before consultation services are rendered.
  • Drs. will be asked to provide UN and PW assigned by Align to access patient information.

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