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.