Quick Doc Coder Order Form
  • Complete the following information.
  • Complete one Order Form for each Practice Partner(TM) licensed practice
  • Enter User Name to register each PC
    • User Names are only used for initial registration. They are not Windows Users.
    • The User Name should identify a specific PC (it can be the PC's name or the name of the PC's user).
  • Enter Registration Number for each PC (Click Help, About to view this).
  • You do not need to register all PCs now. Additional PCs may be registered later by emailing Registration Numbers and User Names.
  • When form is completed, click Register button.

Office Location #1
Office Name      
Office Address
Address Line 2 
City
State
Zip
Country
Phone
Fax
E-mail

Office Location #2
Office Name      
Office Address
Address Line 2 
City
State
Zip
Country
Phone
Fax
E-mail

Office Location #3
Office Name      
Office Address
Address Line 2 
City
State
Zip
Country
Phone
Fax
E-mail

Price
Practice Size
Sales Tax
Total              $ 
                       
Payment Type  Credit Card  Check

Registration Information
PC #1 User Name
Registration Number
  
PC #2 User Name
Registration Number
  
PC #3 User Name
Registration Number
  
PC #4 User Name
Registration Number
  
PC #5 User Name
Registration Number
  
PC #6 User Name
Registration Number
  
PC #7 User Name
Registration Number
  
PC #8 User Name
Registration Number
  
PC #9 User Name
Registration Number