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Independent Practice

Order Information
Independent Practice
How many providers will be using our system
How many cases included in your plan
$
Total cost of your plan
Account Information
Your first name
Your last name
Your email address
Your phone number
Practice name where you work
Practice address
Billing Information
First name
Last name
Your billing address

Please note that all accounts set up to be invoiced will require a 5-day verification period, at which time you will receive your account details and login information. Payment terms on all invoices NET 30. Access to dashboard and mobile application will be granted upon payment.
Your credit card number
Exp month
Exp Year