The problem

Dr. Peter K. Cudjoe is an oral and maxillofacial surgeon opening a practice in Miami focused on one thing: third-molar extractions under IV sedation or general anesthesia. When he came to us his credentialing was about three weeks old. The practice questionnaire came back with "no" or a blank for nearly every line. No practice management system, no hardware, no vendor relationships, no compliance documents. One surgeon, one nurse practitioner, a bilingual patient base, and no front-desk staff.

The brief was to build the layer a receptionist normally is: answer the phone, screen the patient, quote what can be quoted, book the consult, collect intake and consent, and remind people to show up. And to do it in a way that a Florida dental regulator, a HIPAA auditor and a nervous patient at 11pm would all be fine with.

What the practice needed

A phone line that is always answered: Bilingual, honest about being an AI, and able to hand off to a human on defined triggers.
Booking that is real: Every appointment the agent offers has to exist in the schedule, with intake screening before it is confirmed.
Compliance as code: Consent, retention, PHI handling and advertising rules that the codebase enforces rather than a binder describes.
A public site that converts and complies: Procedures, cost, financing, emergencies and a Notice of Privacy Practices, fast and accessible.

How AI is used

A voice agent with the disclosure first

The practice line is answered by Ava, a Retell AI voice agent running in English and Spanish. The very first audio a caller hears is the recording and AI disclosure, played before speech recognition starts, because Florida requires all-party consent to record. The agent's prompts are versioned markdown files in the repository, reviewed like code, and never edited in the vendor console, where we found identity and storage settings drifting from what the practice had approved.

Four agents, each with a narrow job

Scheduling

Checks availability and books through two tools that exchange signed, opaque offer identifiers. The model never sees or invents a raw time slot.

Insurance and eligibility

The practice is in network with twelve dental plans. On a call, a check_insurance tool tells the caller straight away whether their plan is one of them, runs a live 270/271 eligibility check through Stedi, and gives a verified caller their oral surgery benefits as ranges, so a patient learns what is covered before the consult, not after.

Intake and consent

Collects history and consent online or by phone. Red flags such as bisphosphonates, anticoagulants and cardiac history are evaluated by deterministic code. The model only summarizes, with the patient's name stripped, under a BAA.

Recall and smart-fill

Reminders, unsubscribe and email preferences, and filling cancelled slots from a waitlist, all with retention rules checked in CI.

What the agent is not allowed to do

The highest-risk failure we identified was the voice agent quoting a price. Florida's dental advertising statute makes an "all-inclusive" fee claim non-compliant, so pricing moved to written quotes after consultation, and the agent's rules were rewritten and tested against that. A regression suite replays call scenarios with personally identifiable information redacted, and when it has nothing to replay it says so loudly instead of reporting a pass.

How we built it

Two apps in one monorepo

The marketing site has no client components. Every page arrives as complete HTML in the first response, because the AI answer engines the practice wants to appear in fetch pages without running JavaScript. A build check fails on any client component, and the content security policy blocks hydration on purpose, so nothing on the page waits on a script. The only JavaScript a browser downloads is the Next.js runtime, about 142 KB compressed and loaded asynchronously, kept out of the first paint and held under a 150 KB budget in CI, plus a small consent script. Google Analytics loads only after a visitor allows it in the cookie banner. That is what keeps a healthcare site fast on a phone in a parking lot. The clinic app carries online booking, emergency booking, intake and the staff portal, on Supabase with the HIPAA add-on and row-level security from the first migration, hosted on Vercel Pro under a business associate agreement.

Open Dental is the system of record, isolated behind a strict adapter boundary so the practice can change practice-management software without rewriting the agents. Twilio, Paubox, Dropbox Sign, Brivo door access, Stripe and camera integrations sit behind the same kind of boundaries.

What shipped

Marketing site: home, the practice, the surgeon, per-procedure pages, cost, financing, your visit, emergency, for referring dentists, articles with scheduled publishing, privacy and HIPAA notices, accessibility

Clinic app: web appointment requests with a preferred time behind a Cloudflare Turnstile check, intake screening, emergency booking, confirmation, unsubscribe and email preferences

Staff portal: day view, bookings, call and transcript review, agents, compliance, integrations, KPIs

Retell voice agent with booking and insurance tools, bilingual prompts, a disclosure-first call flow and a callback offer

Custom CI gates covering copy, contrast, schema, accessibility, crawlers, client components, JavaScript budget, PHI, agent rules and retention, plus answer engine and evidence checks on articles

Two-layer cookie consent with Google Analytics and booking and call events that only run after a visitor allows them

Permanent redirect from the legacy subdomain to the practice's own domain

Timeline

30 July 2026: Initial specification and site. Practice questionnaire returned the next day.
5 to 7 August 2026: General anesthesia permit confirmed. Practice address corrected across every surface.
27 August 2026: Retell booking tools and patient online booking live.
28 to 29 August 2026: Cash-first pivot with compliant pricing language, Notice of Privacy Practices, email preferences, design overhaul, agent regression suite, call-review console and staff portal relocation.
23 September 2026: Bookings capture who the patient is, and the clinic line is published.
14 October 2026: Consent-gated Google Analytics on the marketing site. Web booking becomes an appointment request with a preferred time, behind Turnstile, honeypot and fill-time spam checks. The voice agent gets a shorter greeting, a callback offer and booking up to 60 days out.
15 October 2026: In network with twelve dental plans. The voice agent's insurance tool answers in-network questions and runs live eligibility through Stedi.
19 to 20 October 2026: Verified callers hear their oral surgery benefits as ranges. Two-layer cookie consent with a settings dialog.

The live site and booking today

Captured from wisdomtoothclinicmiami.com and the booking app in October 2026. A Book button leads through a quick spam check to the appointment request, where a patient picks a preferred consultation time and the practice calls to confirm it.

The Wisdom Tooth Clinic booking page on desktop: Request an appointment, with preferred consultation times listed by day — Appointment request on desktop

The Wisdom Tooth Clinic homepage on a phone: Wisdom teeth, handled properly — Homepage on a phone

The Wisdom Tooth Clinic appointment request on a phone, with preferred times for Friday and Monday — Booking on a phone

Problems worth talking about

47 booking links to a hostname with no DNS

Every Book button on the site pointed at a hostname that did not resolve. The request failed before returning a status code, so every link checker passed. We added a check that resolves hostnames, and fixed all 47.

Vendor console drift

The voice vendor had no recording-capture toggle, a storage setting that did less than its name suggested, and an agent identity that read like a person. The agent-rules check now catches three such violations at once.

The unstaffed clinic that could not exist

Florida requires a staffing floor for general anesthesia, which ended the idea of an unstaffed premises. The product was renamed and rescoped to "no front desk" rather than "no clinic," and the marketing was corrected to match.

Fewer services, truer site

Four service lines the surgeon does not perform were removed from the site and the agent's vocabulary, so nothing is promised that cannot be delivered.

Where it stands

Targets, stated as targets

The build plan sets acceptance gates: booking conversion above 55%, human hand-off under 15%, no-shows under 6%, waitlist fill above 70%, intake completion above 90%, verified across 20 staged calls and 12 emergency transcripts. The practice is newly opened and those are not yet measured, so this page does not report them as results. What we can state is that the site and web appointment requests are live, the voice agent is deployed and answers insurance questions for twelve in-network plans, and the whole platform went from first commit to live booking in 31 days.

Red flags are deterministic code, not model output.
— Zero Front Desk engineering rule

What This Project Does Well

Recording and AI disclosure plays before speech recognition starts, meeting Florida's all-party consent rule

Agent prompts are versioned markdown in the repo, never edited in the vendor console

Intake summaries go to OpenAI server-side with the patient's name stripped

A PII-redacting regression suite replays real call scenarios and refuses to fake a pass when there is nothing to replay

Custom CI gates for copy, contrast, schema, accessibility, crawlers, client components, JavaScript budget, PHI, agent rules and data retention

Google Analytics loads only after a visitor allows it in a two-layer cookie consent, and never on the clinic app where patient data lives

Web appointment requests sit behind a Cloudflare Turnstile check, a honeypot and fill-time spam checks

Legacy subdomain permanently redirected to the practice's own domain

Technologies Used

Next.js App Router, TypeScript strict, Node 22, pnpm and Turborepo monorepo, Supabase Postgres (HIPAA add-on, RLS) and Edge Functions, Vercel Pro with BAA and Vercel Cron, Retell AI, Twilio voice and SMS, Stedi 270/271 eligibility, Cloudflare Turnstile, consent-gated Google Analytics, OpenAI under BAA, Paubox, Dropbox Sign, Brivo access control, Stripe, Open Dental adapter boundary, Vitest, Playwright

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Miami AI Agent Clinic

Ava, the voice receptionist

Booking that cannot hallucinate

Intake with deterministic red flags

HIPAA posture from day one

A site built for patients, not for scripts

Staff portal