OUTCOMES ASSESSMENT AND REPORTINGToday's date: Sunday February 05, 2012

NEW ACCOUNT SETUP - STEP 1

NO CREDIT CARD OR PAYMENT INFORMATION REQUIRED FOR TRIAL ACCOUNT

The account you create will apply to your clinic as a whole. You will be able to add multiple providers at the same location once your account is created. You do not need to create a separate account for each provider unless you prefer to do so.

NOTE: If you have more than one office location, you should create a separate account for each location to ensure meeting patient privacy requirements.

The first step is to complete the registration form below. The trial period lasts 30 days. At the end of the trial you can create a regular subscription. You will not be billed until you have completed the trial and set up a regular subscription. Required information is marked with a 

Complete the form below and then click the Next button to continue with the sign-up process.


To qualify for a REFERRAL discount, please enter the KEY CODE if you have one:

Key Code:

  Not required

First Name:

 

Last Name:

 

Clinic Name:

 

Address:

 

City:

 

State/Province:

  
(State/Prov required for US and Canadian accounts)

Zip/Postal Code:

 
(Zip/Postal code required for US and Canadian accounts)

Country:

 

Phone:

 
(US and Canadian accounts please use 000-000-0000 format)

Fax:

Email:

 
(valid email required to receive payment receipts, update notifications)

User Name:

 

Password:

 Confirm:  
(6 - 12 alpha numeric characters required)
 

Please click once and wait for response:  

 
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