Accurx Plus Order Form

Thank you for your interest in purchasing Accurx Plus! 😊

Please only complete this form if your patient list size is less than 90,000 and if you're certain that you will be procuring part or all of Accurx Plus.

We grant access to new products twice a week, on Tuesdays and Fridays so please be aware it may take a few days to have access to the products you choose to purchase.

You can learn more about all Accurx Plus products here: https://link.accurx.com/accurxPlus

This form is made up of the following 4 pages:
1. Contracting details
2. Details on the practice(s) covered in this contract
3. Which products you would like to purchase
4. Confirmation of request for a contract

If you have any questions, please email partnerships@accurx.com.
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Your name *
Your email *
Your role *
Name of the contracting organisation *
This should be the name of a practice or lead practice if contracting on behalf of a PCN.
Full address of the contracting organisation *
Including postcode
Finance contact name *
This is the person who will be contacted about billing in the future
Finance contact email *
There is a license fee based upon list size for each of our products. There is also additional SMS costs based upon usage which is not included in the license fee. Please confirm you understand that the practice will be invoiced for these SMS costs if your CCG has not agreed to pay. *
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