OrthoFi Solutions Submission

Office Location*

Your Name*

Your Email Address*

Your Role*

Specific Patient Issue?*

We need specific examples when it comes to issues like Insurance, account glitches, etc. If for example the website is down you do not need to give a patient example

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Patient Name*

OrthoFi Account Number*

What do you need help finding a solution to?*

If you are unsure of how to do something like adding a patient, taking a payment etc. please utilize the OrthoFi documents section of the Training & Development page on the Intranet. This form can only help provide solutions for errors in OrthoFi. If you need to check on your permissions settings because you cannot see the right reports, locations or need an account setup, please email IThelpdesk@d4c.com

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Which Insurance issue best fits your scenario?*

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Please provide detail on the insurance issue*

Please do not submit a ticket if you are waiting on the following: - Last Minute Verification of Insurance for Add on Patient - Benefits Not Verified due to Missing Information

Please give us details below:*

If other internet based issues are occurring or there are issues with your PMS (Dolphin, OrthoTrac, etc) please submit a ticket to IThelpdesk@d4c.com before submitting this form. Please also try accessing OrthoFi on multiple devices prior to submitting.

Contract Issue*

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Please explain in detail the contract issue*

If you're unsure of a fee, please refer to the Fee Schedule with Suggested Minimums Spreadsheet prior to submitting. Please visit the OrthoFi Intranet page if you are missing information or are unsure of how to complete a part of the contract process.

Please provide detail on the issues reaching OrthoFi Support*

Please only submit one ticket regarding reaching OrthoFi Support per week unless it is happening daily for more than 2 days. Please provide below the date and time the call was made below, as well as the wait time.

Please explain the issue you are having*

Is the patient ready to start treatment and this is preventing you from doing a contract?*

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