About   How It Works   Benefits   Partners   How To Join   Contact   Member Login    HOME > PRACTICE MANAGEMENT > PRACTICE MAXX Contact - Content Choose one of the following two options:  Yes! I'd Like to Order Practice MAXX! Method of Payment  $19.95 Monthly Payment Plan:        Pre-authorized chequing (For monthly payments. Please include a             VOID cheque).        Credit Card        Credit Card Information Card Type Select One... VISA MasterCard American Express Name of Card Holder Card Number Expiry Date 01 02 03 04 05 06 07 08 09 10 11 12  /  08 09 10 11 12 13  Annual Payment Plan        Bill my office        One Year (Save 5%) $227.43 plus GST        Two Years (Save 10%) $430.92 plus GST Name of Clinic or Office Type of Practice Mailing Address Suite City Province Postal Code Telephone Number Fax Number Email Address Name of Cardholders 1. 2. Please issue personal cards to (note: $2.00 administration fee applies per card): 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.  Yes! I'd Like to Know More About Practice MAXX        Please send me information        Please call me Contact Information First Name Last Name Email Office Address Suite City Province Postal Code Telephone Number Extension Fax Number Medical Specialty Best Time To Call Back  am     pm   Click on Submit to send electronically to Healthy Canadian Networks Or Print Form and fax to Healthy Canadian Networks at 613-729-6206