We have tried to use this system for 1 1/2 years only to have issues daily. The biggest issue is the accounting module, we had a big problem with accounts when we did the conversion and have problems since. It is incredibly easy to incorrectly schedule patients on the wrong day and for the incorrect procedure, any custom reports (patients with over $200 balance) have to be set up by a customer service rep and are typically not the info you needed. Our usual 1 page statements were last sent, some up to 69 pages!!! The suggested statement processing company and Open Dental have had a formatting issue since January but failed to notify customers. I had been accustom to being able to talk to customer service as needed with other systems, Open Dental customer service calls you back at some point throughout the day. Not effective when most of your issues need immediate attention.