Clinic Order Form

Status: Draft for legal review Document key: clinicOrderForm Version: 2026-05-31 Use: Accepted billing snapshot before clinic activation

Customer

• Legal clinic entity:
• DBA / practice name:
• Primary contact:
• Billing contact:
• Practice address:
• Branch name:
• Open Dental customer identifier, if known:

Service

Happy Light AI provides AI receptionist, call handling, scheduling assistance, call logs, follow-up workflows, and Open Dental workflow support for the clinic branch identified above.

Plan

Base plan:

• $149 per month
• 300 included AI conversation minutes per monthly billing period
• English included as the default language

Usage after included minutes:

• $30 per started 60-minute block if automatic recharge is enabled
• If automatic recharge is disabled, AI answering may pause when included minutes and purchased credits are exhausted

Optional add-ons:

• Additional language: $10 per month per additional language
• Other add-ons: as listed in the dashboard or written amendment

Discounts:

• Discount type:
• Discount amount:
• Discount label:
• Discount expiration, if any:

Billing Start and Renewal

Billing begins when the customer completes checkout or accepts this order form, unless a later start date is expressly stated. Monthly service renews automatically until canceled according to the Terms of Service.

Activation Conditions

Clinic features may activate after:

• payment method is valid;
• required agreements are accepted;
• BAA is executed where applicable;
• AI answering number is assigned or requested;
• Open Dental CustomerKey is revealed, copied, connected, or otherwise configured; and
• required branch setup steps are complete.

No Setup Fee

Unless otherwise stated in a signed order form, there is no separate setup fee. The first monthly subscription charge is prepaid and subject to the Activation and Refund Policy.

Clinic Acknowledgements

The clinic acknowledges:

• Happy Light AI does not port the clinic's main number.
• The clinic or phone provider is responsible for configuring forwarding.
• The assigned AI number is intended for voice calls only unless text handling is separately enabled in writing, and inbound SMS/MMS messages to that number are not monitored or answered by Happy Light AI.
• Happy Light AI does not verify insurance benefits or submit claims.
• Happy Light AI does not provide clinical advice.
• Staff remain responsible for reviewing follow-up tasks and patient needs.
• Open Dental configuration must be accurate for the service to work safely.

Accepted Documents

This order form should be accepted together with:

• Terms of Service
• Privacy Policy
• Business Associate Agreement, if applicable
• Recurring Payment Authorization
• Activation and Refund Policy
• Open Dental API Authorization
• AI Phone Number and Forwarding Disclosure

Signatures

Customer authorized signer:

Name:

Title:

Date:

Happy Light Tech:

Name:

Title:

Date: