Order Form
for Millennium Healthcare Consulting, Inc® Products
Print this form and send it to us by mail or fax. Our address and fax number are at the bottom.
Product Description Quantity Price Total
Office Progress Note Template

On-line
On Disk

   $FREE
$15.00		  

Subtotal

 

Shipping Method (Please circle one):             • First Class Priority    • UPS Ground    • Overnight

  

Grand Total

 $

Please mail orders to the following address:
Millennium HealthCare Consulting, Inc.
P.O. Box 1071
Lansdale, PA 19446
or fax orders to (215) 362-1494
Please make checks payable to:
Millennium Healthcare Consulting, Inc.

Organization/Practice Name                                                                           

Individual                                                                                                         

Address                                                                                                            

City                                                            State                Zip                         

E-mail Address                                                                                                

Daytime Telephone                                                                                          

Fax Number                                                                                                      

Referral Source Name                                                                                     

Please check method of payment:          VISA            Mastercard        ___Check

Card Number                                                        Exp. Date                          
Please allow 1 week for processing and delivery.
Please review your order carefully. No cancellations/refunds allowed. If product is damaged, we will replace at no charge. Thank you.
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