Practice Perfecters, Branding & Design & Marketing Collateral for healthcare practices.

Enroll Your Clients NOW!

Step 1: Account Info

Step 2: Build Program

Step 3: Enroll Clients

Step 4: Payment

ABOUT YOU (SURGEON)

Let’s talk about you! This one-time information form to set up your account is for new customers. It will be used solely for the purpose of providing Patients+ services. (see Privacy Policy)

NOTE: (*) indicates required information.

First Name *

Last Name *

Title

Company Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone Number: *

Cell Phone Number:

FAX Number:

Email Address *

Website URL

How did you hear about us? *

CONTACT INFORMATION

Who is the person within your practice who is authorized to upload data and make changes to your Patients+ Account?

First Name *

Last Name *

Title

Phone Number: *

Email Address *

Preferred Hours of Contact

ACCOUNT INFORMATION

Please provide password information that will be used to manage your account.

Password *

Confirm Password *

Password Hint *

MAILING CUSTOMIZATION

You may upload your own logo, signature, and picture. Please see our technical specifications for size and quality contraints, or contact us for help

Logo

Do Not Use my Logo

Upload my Logo

Signature

Do Not Use my Signature

Upload my Signature

Use this Signature

Picture

Do not Use my Picture

Upload my Picture