ACE Plugin Order Form
Simple steps to order a plugin:
1) Complete the form below and hit submit
2) Aventria team will call to confirm the order and confirm your customer's logo for the tools
3) Your customized plugin will be ready in 2 weeks

If you have any questions, please contact support@accessclickengage.com
Account Manager Information
Salix Team *
Your name *
Your email *
Your phone number *
Customer Information
Customer organization name *
Customer contact name *
Customer email *
Customer Organization Type *
Customer role *
What Salix zones will the plugin be accessed for? (required for IAM and INAM)
Plugin Utilization
What care setting/department will be utilizing the plugin? *
Required
Who at the Customer will have access through the plugin from their HIT-EHR system? *
Required
Plugin Tool Information
What patient populations are they focused on?
What plugins and tools would they like?
Customer logo on the tools? *
For Assistance
Please contact the ACE team at support@accessclickengage.com

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