First Pacific Funding Finance Applciation 
EMR4Doctors Licensing
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Please try the software for free before you buy.
Order Products Price Support & Updates
EMR4 Charts Patient Charting PDA Version Only
Pocket PC Charting Software for a 64MB Pocket PC for 1 Doctor at 1 Location.		 $249.00
$99 This month
PPC Version Only - 1 year of
E-Mail Support and Product Updates.
Patient Charting for One PC Computer & PDA
Advanced Patient Charts Software for 1 Location, 1 Doctor, 1 Pocket PC, 1 Desktop PC Workstation		 $1195.00 $595 This month
 1 year of Phone Support and Product Updates. Free Software Updates online for 1 year.
Network Patient Charts Software
Multiple PC Computers & PDAs
1 Location, 1-20 Doctors, 1-3 Pocket PC's, 1-10 Desktop PC Workstation Network, Wireless Printing, Messaging, Sync Options. 		$1795.00
$895 This month
 1 year of Phone Support and Product Updates. Free Software Updates online for 1 year.
EMR4 Billing & Scheduling
Billing & Scheduling for One Computer
Single user software for billing insurances, patients, schedule appointments. 1 Location, 1-10 Doctors

$1195.00
 $595 This month

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

Billing & Scheduling for Multiple Computers
Network software for billing insurances, patients, scheduling appointments. 1 Location, 1-20 Doctors and
1-10 networked computers.

$1795.00
 $895 This month

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

EMR4 Document Management
Multi-Media File Management Software to store all types of documents for 1 Location, 1-20 Doctors, 1-10 Desktop PC Networked Workstations.

$2995.00
$1499 This month
 1 year of Phone Support and Product Updates. Free Software Updates online for 1 year.
  EMR4 Web
Custom Designed Web-Based MS SQL Server electronic medical records system with E&M patient charting tools and integrated billing and scheduling.
Custom Quote Required
Custom Support and Updates Options will be discussed at the time of purchase.

 
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
      
    

  

  

  
 

    I have read and understand the software license agreement.

    Signed ______________________________________ Date ___________________________ 

    Fax this page with your signature and information to 877 293 7925 
	 or 702-896-9675

	or by mail to
  EMR4 Doctors, 1481 Sequoia Dr, Hebron KY 41048





Orders over $99 will have free FedEx shipping.  Orders $99 and less are sent US Mail.  


Your license to turn off the trial can also be sent via email if you are in a rush.