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User Intake
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Complete this form for EACH user in your practice.
Practice Name
Users First Name
*
Users Last Name
*
Create a Public Username
*
This username is the name that clients use to identify the user. Examples are "Dr. Sara" and "Karen".
User's Email
*
What Privilege Set Should This User Have?
*
Practice Owner
Practice Manager
Practice User
A Practice Owner has unlimited access, a Practice Manager has full access but cannot reset user passwords, and a Practice User has limited access and is designed for veterinary staff, administrative staff, and Care Coordinators. Select 1 option
What position does the user fulfill in the practice?
Veterinarian
Technician
Care Coordinator
Administration
Practice Manager
Owner
Select all that apply.
What devices will the user utilize REX on?
iPhone
iPad
Apple Computer
Windows Computer
Select all that apply.
Will the user be storing controlled medications?
Yes
No
If so, what is the address where the medications will be stored?
Will the user be seeing patients?
Yes
No
Date User wishes to become active
Date Format: MM slash DD slash YYYY
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