Training Purchase

What product will you be training on? *

Are you currently in a training session and need to purchase additional hours? Min order is one (1) hour. *

Is this request for adding the In-Office Travel Fee? Only use if the In-Office Travel Fee was omitted from a previous order request. *

Who is the HS One representative assisting you with this training request *

Preferred Trainer Name

Training Method *

PLEASE NOTE: There is a $182.00 onsite travel fee per day for in-office training in addition to our hourly training rate.

Select In-Office Training Hours & Fee *

Select Online Training Hours & Fee *

Dentrix Ascend Online Training Hours & Fees *

Please indicate the number of training sessions. *

Day 1 - $182.00 onsite travel fee per day of in-office training *

$182.00 Per-Day Travel Fee

Day 2 - $182.00 onsite travel fee per day of in-office training *

$182.00 Per-Day Travel Fee

Day 3 - $182.00 onsite travel fee per day of in-office training *

$1820.00 Per-Day Travel Fee

Day 4 - $182.00 onsite travel fee per day of in-office training *

$182.00 Per-Day Travel Fee

Day 5 - $182.00 onsite travel fee per day of in-office training *

$182.00 Per-Day Travel Fee

Day 6 - $182.00 onsite travel fee per day of in-office training *

$182.00 Per-Day Travel Fee

Preferred Date of Training
*Note - your training date will not be confirmed until you are contacted by a training coordinator. +

Preferred Date of 2nd Training
*Note - Your training date will not be confirmed until you are contacted by a training coordinator. +

Preferred Date of 3rd Training
*Note - Your training date will not be confirmed until you are contacted by a training coordinator. +

Preferred Date of 4th Training
*Note - Your training date will not be confirmed until you are contacted by a training coordinator. +

Preferred Date of 5th Training
*Note - Your training date will not be confirmed until you are contacted by a training coordinator. +

Preferred Date of 6th Training
*Note - Your training date will not be confirmed until you are contacted by a training coordinator. +

Preferred Day(s) of Week for Training *

Account Details

HS One Customer Number * 🛈

Practice Name *

Contact Name *

Practice Phone Number *

Email Address
*

Email Confirmation *

Street Address *

Address Line 2

City *

State *

Zip Code *

Training Agreement

Terms of Training:

1. The software for my training session has been installed and is functioning properly in my office.

2. I will not hold HS One and/or its Certified Trainer responsible for any interruptions to the training that may occur due to incoming office phone calls, patients, office construction, computer/network problems, etc.

3. The trainer is not authorized to install software or troubleshoot systems.

4. Cancellation of training with less than 48 hours notice may result in charges for the training.

5. Any recording of the training session is prohibited.

6. Training hours expire 1 year from the purchase date unless training has been purchased at a discounted rate.

7. There is a travel fee of $182.00 per day for in-office training. If the training delivery method changes or additional in-office visits are needed, HS One will contact the office to make adjustments.

*

I understand and acknowledge the terms related to the purchase of additional training.

Terms of Training:

1. The software for my training session has been installed and is functioning properly in my office.

2. I will not hold HS One and/or its Certified Trainer responsible for any interruptions to the training that may occur due to incoming office phone calls, patients, office construction, computer/network problems, etc.

3. The trainer is not authorized to install software or troubleshoot systems.

4. Cancellation of training with less than 48 hours notice may result in charges for the training.

5. Any recording of the training session is prohibited.

6. Training hours expire 1 year from the purchase date.

*

I understand and acknowledge the terms related to the purchase of additional training.

Henry Schein One Terms and Conditions

I hereby select the Services and Payment Option(s) marked above and agree to the Terms and Conditions for the service(s) I choose to purchase. Interest charges of 1.5% per month and 18% APR (or the highest rate permitted by law if lower than 1.5% per month) will accrue on any unpaid balance which is more than thirty (30) days overdue. Past due balances could result in the termination of services and/or support being withheld until payment obligation is met. Prices do not include applicable sales tax and are subject to change without notice. I have read this Agreement in its entirety and I understand and accept all of the provisions stated herein. By signing this agreement, I hereby authorize and approve the transmission by HS One and Henry Schein, Inc. (and all affiliates, divisions, representatives and agents thereof) of all advertising and other faxes to the fax number(s) identified in this agreement for news and information regarding products, services and specials. This consent shall be valid until revoked in writing by an authorized representative of the licensee.

*

I have been authorized by the practice owner to register for additional training and agree to terms and conditions relating to Henry Schein One products.

Customer Signature (Authorized Representative) *

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Full Name *