MedView Paperless Claiming Subscription

MEDVIEW PAPERLESS CLAIMING SUBSCRIPTION

This form is to subscribe to MedView Paperless Claiming

Pharmacy name *

Pharmacy Approval Number *

Primary contact *

Pharmacy address *

Pharmacy Email Address *

Pharmacy phone number *

MedView Paperless is currently available for Fred Dispense, Aquarius Dispense, Minfos, Mountaintop Dispense and Z Software customers only. Are you using one of these systems? *

Yes *

If yes, do you agree to eRx charging your account $720.00 (inc. GST and freight) for the delivery of the Fujitsu ScanSnap ix1500 document scanner. The payment will be a once off amount, debited or invoiced 30 days from the date of order. *

Yes *

If yes, would you like to activate Paperless and order a Fujitsu ScanSnap ix1500 document scanner? *

Yes *

I accept the Terms & Conditions of MedView Paperless Claiming ($50 per month on a 12 month contract) on behalf of this Pharmacy *

Yes *

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Terms & Conditions