Practice Director eRx Renewal

To renew your Practice Director Subscription complete the form below.

Practice Director Renewal

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Name*

First Last

Title*

Email*

Legal Practice Name*

Practice/Store Phone Number*

EIN Number*

Legal Address*

Street Address Address Line 2 City State ZIP Code

Dr First Acknowledge $549 Billing*

Dr First Acknowledge $549 Billing* By typing my name I request that my Practice Director Dr First Provider account be renewed for a partial period ending 12/01/2024. I understand that I will be billed for a full year at $549 and that the pricing cannot be prorated or refunded. If my request is not received prior to my renewal date I understand that my account cannot be renewed and I will not be billed.