Request for Reduction of Medtech Evolution License(s) on Medtech Cloud

 
 
Customer No*
 
 
 
 
Customer Name*
 
 
 
 
Requestor’s Name*
 
 
 
 
Requestor’s Position*
 
 
 
 
Email:*
 
 
 
 
Phone Number*
 
 
 
 
Date required for this to be actioned*
 
 
 
 
Number of licenses you wish to reduce by:*
 
 
 
 
 
 
Upload a copy of your current Medtech Evolution licensing screen *
 
 
 
 
 
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 
 
 
 
Privacy Policy
 
 
I have read and accept the Privacy Policy and I am authorised to make this commitment on behalf of my organisation.*
 
 
      See Privacy Policy 
 
 
Please note: There is a 24 hour turn around period on new license details being returned to the practice
  
 
 
 
 
 
 
 
 
 
 

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