Home

EMR4Doctors Upgrade Sales Order Agreement
Order Renewal Options Price Renewal Includes

1. EMR4 Single Workstation Renewal
 of Modules Purchased

$399.00

1 year of Phone Support and Product Updates. Free Software Updates online for 1 year.

2. EMR4 Network Renewal
 of Modules Purchased
$599.00
1 year of Phone Support and Product Updates. Free Software Updates online for 1 year.

3. EMR4 Network Pro Renewal of Modules Purchased
$799.00
1 year of Phone Support and Product Updates. Free Software Updates online for 1 year. 
Please charge my credit card this amount:   Plus Tax and Shipping (Added to total)
 Information on credit card Type of Card   Exp Date:
 Special Instructions:
Card Number
First Name, Initial, Last Name on Card
Card billing address
City State Zip/Postal Code
Phone 
Clinic Address Changed?  Please update your information below:
Signature Name for Charts
Clinic Name 
Clinic Address
City State Zip/Postal Code
Clinic Phone
Email for notification of changes
Referred By
Your renewal file will be emailed and a CD sent by regular mail.
I have read and understand the software license agreement.
Signed ______________________________________ Date ___________________________
Fax this page with your signature and information to (877) 293-7925 or mail to
EMR4 Doctors, 1481 Sequoia Dr, Hebron Ky 41048