Practice verifying a suspicious request

We'll send a safe, simulated phishing email to up to three of your staff, then turn any click into a quick teachable moment — no patient information or passwords are requested. Participant contact details and test activity are recorded. Here's how it works:

1
Sign up your team
Tell us about your practice and add up to 3 staff members you want tested.
2
E-sign the consent
Read and electronically sign the authorization agreement right here — no printing needed.
3
Review and schedule
After authorization is recorded, we review the scope and arrange the simulation.
4
Turn clicks into training
Anyone who clicks is redirected to a short, non-punitive lesson. No passwords or patient information are requested; delivery and click activity are recorded.

Authorization comes first. Fill in the details below, then read and e-sign the authorization agreement at the bottom of this page. Your test won't begin until it's signed — we attempt to email a signed copy to you and to [email protected]. Check the confirmation message for email acceptance.

Practice & authorization details

The representative below must have authority to approve this scoped email simulation for the practice.

Dental practice name *

Practice address

Doctor's name

Authorized representative *

Title / role

Representative email *

Phone

Staff members to test (up to 3)

Staff member 1 *

Name

Work email

Role / title

Staff member 2

Name

Work email

Role / title

Staff member 3

Name

Work email

Role / title

Authorization & consent agreement

Please review the agreement below, then e-sign to authorize the test.

Phishing Simulation Authorization & Consent Agreement

This Phishing Simulation Authorization and Consent Agreement (the "Agreement") is entered into by and between SentryGuard Dental ("Service Provider") and the dental practice signing below ("Client").

1. Purpose and Scope of Testing

Client hereby authorizes SentryGuard Dental to conduct controlled, simulated phishing and social engineering exercises (the "Simulations") targeting Client's designated corporate email systems, networks, and personnel. The sole purpose of these Simulations is to evaluate cybersecurity awareness, identify vulnerabilities in employee behavior, and provide remedial security training.

2. Methodologies and Execution

Simulation Vectors: Simulations may include mock phishing emails, fake login landing pages, and simulated QR-code (quishing) vectors designed to mimic real-world cyber threats.
Safety Guarantee: The Simulations will contain no real malicious code, ransomware, or destructive payloads. No actual client data, network configurations, or electronic systems will be altered or harmed.
Remediation: Employees who interact with a simulation (e.g., clicking a link or entering mock data) will be immediately redirected to a secure, non-punitive educational landing page or micro-training module.

3. Data Privacy and PHI Handling

SentryGuard Dental acknowledges that Client operates a dental facility subject to healthcare privacy regulations, including HIPAA.

No PHI Collection: The Simulations are strictly structured to avoid capturing, harvesting, or storing any authentic patient data or Protected Health Information (PHI).
Data Security: Any metadata collected during the assessment (such as click rates, open times, or aggregate department failure rates) will be treated as strictly confidential and shared exclusively with Client's authorized management.

4. Limitation of Liability

The Simulations and associated reporting are provided on an "as-is" and "as-available" basis for educational and risk-awareness purposes only.

No Warranty: SentryGuard Dental makes no guarantees that these exercises will detect or prevent all future real-world cyberattacks or phishing attempts against Client.
Liability Cap: To the maximum extent permitted by law, SentryGuard Dental, its officers, employees, and subcontractors shall not be liable to Client for any direct, indirect, incidental, consequential, or punitive damages. This includes, but is not limited to, business interruption, loss of data, operational downtime, or successful third-party cyber breaches occurring before, during, or after the term of this Agreement.

5. Authorization and Sign-Off

By signing below, the authorized representative certifies that they possess the corporate authority to grant network testing permission for the Client's domain and email infrastructure.

By typing my name below and clicking "Sign & authorize", I certify that I am the authorized representative of the practice named above with authority to approve network testing, and I agree to the terms of this Agreement. I understand this constitutes my legal electronic signature under the U.S. ESIGN Act and applicable state law (UETA).

Type your full name to sign *

Date

Your typed name is your electronic signature under the U.S. ESIGN Act. A signed PDF copy is requested by email. Delivery is confirmed separately.

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