Request for Additional Evolution License(s)


Please complete the below form and one of our Medtech team will respond with a written quote within 24 hours.

Note: The per License fee for additional users is related to your total number of licenses.
 
 
 
 
Customer No*
 
 
 
 
Customer Name*
 
 
 
 
Requestor’s Name*
 
 
 
 
Requestor’s Position*
 
 
 
 
Email Address:*
 
 
 
 
Phone Number*
 
 
 
 
Date required to implement this changes*
 
 
 
 
 
 
 
I/We require an additional Evolution license(s). 
How many licenses do you require?*
 
 
 
 

Note: Go to Help/Register option on the Menu Bar and use a snipping tool to take a screenshot. If the snipping tool is not available, please do CTRL + SHIFT + Print Scrn and then paste it on a word document. Please save it on your computer and upload that file

 
 
 
 
Upload a copy of your current Medtech Evolution licensing screen *
 
 
 
 
 
Privacy Policy
 
 
I have read and accept the Privacy Policy and I am authorised to make this commitment on behalf of my organisation.*
 
 
I/We acknowledge that our monthly support and development fees will increase by 1 workstation fee per additional license.*
 
 
     See Privacy Policy


Please note: There is a 24 hour turn around period for new license details being returned to the practice. 
 
 
 
 
 
 
 
 
 

Note: Your request will be processed within 1 business day.