Request an interface you would like to connect to from MEDENT

Please fill out the following form to request an interface that your practice would like to connect to from MEDENT.

This form should be used for NEW interfaces only. If MEDENT is already connected with the third party, please submit a support ticket. For a list of available interfaces please click here.

This form should be completed by the Medent Practice requesting the interface. A practice contact and vendor contact are required for any new request to be reviewed.

MEDENT Account Number:*



Medent Practice Contact Name and Number:*

Medent Practice Contact Email: *



Name of the company that you are looking to interface with:*



Note: In order to review this request we will need a direct contact with name, email and phone at the company who would be knowledgeable about interfacing.

Interface Contact Name:*

Interface Contact Phone:*

Interface Contact Email:*

Have you already contracted with the interface? *



What are you looking to accomplish with this interface?*



What is the ideal workflow?*



Any other information you would like to provide?



Do you plan to use this interface to meet specific program requirements? If so, please indicate the program.



Please attach official specifications if you have them (8MB max)
(.png,.jpg,.jpeg,.pdf,.xls,.xlsx,.doc,.docx,.tiff,.tif)


Completed forms will be reviewed and researched by the interoperability department. It is recommended that your practice submit an interface request form prior to signing any formal agreements with a third party. Submission of this form does not guarantee an interface can or will be developed.

Interface requests will be reviewed by our team as soon as possible. Due to increased interface demand and request volume, this may take some time. When our team is able to start the discovery process, we will work with the practice and vendor to determine if a new interface is possible. Our networking team will also need to confirm a secure connection can be established. Upon completion of these items we will issue a quote to the practice.

Programming for any new development will not begin until the practice has returned a signed quote and initial development fees have been paid. The development process should then take 4-8+ months for programming, testing and implementation.