Dental Remote-Support Provider Information Request

Ask the provider to answer every field. Use “not offered” or “not disclosed” instead of leaving blanks.

Company and delivery model

• Legal company name and headquarters: ______
• Countries where the work is performed: ______
• Staffing only / staffed and managed / function-level service: ______
• Worker employed by provider / contracted by provider / other: ______
• Dedicated / shared / pooled staffing: ______
• Typical dental client size: ______

Pricing

• Pricing model and currency: ______
• Rate or range and unit: ______
• Minimum weekly hours or monthly commitment: ______
• Setup fee: ______
• Included: recruitment / management / quality review / device / licenses / training / replacement / reporting
• Excluded or billed separately: ______

Coverage

• Coverage days and exact windows by time zone: ______
• Holiday calendar: ______
• Absence coverage: guaranteed / best effort / none
• Overnight work available: ______

Dental capability

• Number and type of current dental clients: ______
• Dental roles supported: ______
• Practice software supported: ______
• Experience level by system: ______
• Languages and proficiency: ______
• Same-industry references available: ______

Contract and continuity

• Trial available and terms: ______
• Contract length and notice: ______
• Replacement offered: ______
• Replacement conditions and expected timing: ______
• Direct-hire or conversion policy: ______
• Data-return and deletion terms: ______

Security and evidence

• Required healthcare agreement available: ______
• Training program and evidence: ______
• Security certifications, scope, and dates: ______
• Device policy: ______
• Access controls: ______
• Workspace requirement: ______
• Data residency: ______
• Background checks: ______
• Supporting documents attached: ______

Onboarding and quality

• Expected onboarding duration: ______
• Onboarding support included: ______
• Management model: ______
• Quality-review process: ______
• Reporting type and frequency: ______
• Staff turnover disclosed: ______

For every answer, record whether it is provider-stated or supported by an attached document.