Complete this form and click [Submit] to retrieve your activation key. Please verify that all fields accurately reflect the practice you are registering. Once you have successfully registered your product and have the activation key, print this page to keep as a reference for the future.

VAR# VAR (reseller) Name   Number of Users *Serial Number   *Provider First Name   Middle *Last Name   *Required fields





*Registration/Practice Name     *Contact First Name   *Last Name   *Street Address   *City   *State   *Zip     Practice Specialty *E-mail Address     (No Punctuation) *Phone     Fax (No Punctuation)   *Version