Technical Review Form

Practice Name
Practice Facility Code (If known)
Preferred contact person
Practice Address
Address City Postal code
Phone
Contact Email
Practice Management System
Will the practice be performing telehealth services for multiple regions
(if yes, please indicate regions below):
Acceptable User Agreement

The Acceptable Use Agreement can be uploaded using the option below or emailed to helpdesk@eorder.co.nz
Upload acceptable user agreement
Max. file size: 256 MB.
Users requiring access to eclair eOrders
Please add all users that will be required to access the Order form. This may include Doctors, nurses and healthcare assistants and admin staff who require access. Alternatively attach a list of users below using Word or Excel - a template can be found here.
Please add all users that will be required to access the Order form. This may include Doctors, nurses and healthcare assistants and admin staff who require access. Alternatively attach a list of users below using Word or Excel - a template can be found here.
NZMC Title First Name Surname
Attach list of users
Max. file size: 256 MB.
I would like to join the eOrder distribution group
The eOrder distribution group is used to notify eOrder users of updates and actions related to eOrders.

NZMC	Title	First Name	Surname

Acceptable User Agreement