Sign Up

Create an Account

You are steps away from your own DentalBaseCamp account. Use this form to signup. Your personal information and credit card information are securely transmitted to our operation center.

After submitting the form, you'll have instant access to your DentalBaseCamp Online Dental Assistant, Patient Area and Administrative Area.

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Registration Form

Fill out this form to make a payment now.

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ADA Number

First Name

Last Name

Email

Password

Confirm Password

Billing Address

City

State

Zip

Card Type

Visa MasterCard

Card Number

Expiration

01 02 03 04 05 06 07 08 09 10 11 12 / 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Thank You, We appreciate your business

Billing Process

When you sign up for your account, you'll see a charge of $39.00 on your credit card. The charge is from "Wildfire Internet", the developers of DentalBaseCamp.

Each month, your account is billed $39. That charge also shows "Wildfire Internet" on your credit/debit card statement.

Because we believe DentalBaseCamp is a great asset to your customer support efforts and that customers will love it, you are not locked into any type of long term contract. If you would like to cancel the account, simply contact the Wildfire Office (http://www.wildfire.net).

Thank you and we look forward to providing your practice with an infinitely valuable asset!