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AllyDVM Order Form

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Establish Your Account		Select Your Services		Finalize and Accept Terms

Enter your referral code or the name(s) of any corporate group, network, or purchasing group that you belong to if applicable (you may enter multiple).

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NOTE! As a corporate group member, please click here to use or our corporate group order form. Thank you!
Confirm that you're a TVC member.

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Confirm that you belong to Blue River PetCare
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Confirm that you qualify for the New Practice Promotion discounted pricing.
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Confirm that you belong to VSG.

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Confirm that you belong to PetWell Partners.

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Confirm that you belong to VISN.

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Contact Person

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Required First Name Required Last Name
Contact Person's Email

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Full Practice Name

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Is AllyDVM currently installed on your server?

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Practice ID

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If you are currently installed with AllyDVM, enter your Practice ID here.
Practice Email Address

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Practice/Front Desk Phone

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Practice Website

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Enter your website URL. If you don't have one, enter www.none.com.
Practice Manager

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Practice Manager Email
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Who is your Operations Manager?
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Who is your Regional Manager?

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TVC Owner Number

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TVC Membership Enrollment Date
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MM/dd/yyyy
VSG Group Number *
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Practice Address

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Required Street Address Required City Required

State/Region/Province Required Postal / Zip Code

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Country
Practice Management System

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Please note, if your PIMS is not listed, you are not eligible to use AllyDVM.
**Please note there is a $40/mo connection cost for Daysmart/Vetter. You will see a reflection of these costs on your monthly statement from AllyDVM.
**Please note there is a $40/mo connection cost for Cornerstone. You will see a reflection of these costs on your monthly statement from AllyDVM.
**Please note there is a $40/mo connection cost for ezyVet. You will see a reflection of this cost on your monthly statement from AllyDVM.

Automated Postcards are available when you sign-up for our Communication System. Postage pricing in the US is $0.94/standard card or $0.96/custom card. In Canada the postage pricing is $1.20/standard card or $1.22/custom card. Ask your Onboarding &Training Specialist for details!
Our Most Popular Bundles

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Please select the bundle you wish to order. If you do not want to order a bundled solution at this time, please select ORDER INDIVIDUAL SERVICES button.
Standalone Services

All standalone services are available to select in addition to our bundles or as individual features.
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Select Your Services

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Select Your Services

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Select Your Services

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Please check the box to confirm you are aware that Communication Core package will be invoiced at the discounted rate of $150/mo for the first year of your subscription. After that time the cost will return to the standard rate of $295/mo.
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Please check the box to confirm you are aware that Communication Core package will be invoiced at the discounted rate of $150/mo for the first year of your subscription. After that time the cost will return to the standard rate of $295/mo.
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Please confirm you are officially opting in for our Two-Way Texting Feature:

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Do you want your existing landline phone number to be your text (SMS) number?
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Yes - I want to try and use my existing business number as my SMS number.
No - I want a new number assigned with my area code.
**Please note that this option has a setup fee of $112 and does require additional setup time if your number is eligible.**
What is the phone number?
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Do you use SMS on this phone number right now?

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Yes
No
Who is the SMS provider?

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**Please note that you will have to cancel with your current SMS provider before we can host your SMS services on this phone line.
Who in your practice can we call during setup of this SMS number?

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In order to host your SMS number, a phone verification call is required where the end-user answers the phone and passes back a security token to Twilio.
What is the name of the person listed on the bill for this phone number?

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(This person will need to authorize the usage of this number.)
Please confirm that you are officially opting in for our Loyalty Program:

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The loyalty program is not fully automated for the Practice Management System that you have indicated. A manual version is available for implementation at this time.
Please confirm that you are officially opting in for the Analytics Package:

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Please confirm you are opting in for VSG Analytics and DATALINK Transfer. Revenue data will be uploaded quarterly into DATALINK for benchmarking purposes.
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Please confirm you are opting in for VSG Analytics and DATALINK Transfer. Revenue data will be uploaded quarterly into DATALINK for benchmarking purposes.
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Please Note: AllyDVM core dashboards are included with the base cost. A one-time $147 data normalization fee will apply for advanced analytics.
Dashboard User 1 Email:

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Dashboard User 2 Email:

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(if needed)
Dashboard User 3 Email:

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(if needed)
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VMG Trends Report

VMG Trends Report

This is only for members that do not want to use any of the AllyDVM features, but do want to have their data included in the monthly VSG Trends report (emailed to practice owners once a month).

MWI Account ID

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All AllyDVM billing is processed through MWI. Please locate your current MWI Account Number if applicable.
Who referred you to AllyDVM?

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(MWI, AllyDVM website, Colleague, etc.)
Name of your MWI Rep

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(if applicable)
Referral Code
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(if applicable)
Agree to Terms
In order to start your account, you must read and agree to AllyDVM's Terms and Conditions and Privacy Policy.
You have read and accept the Terms and Conditions and understand the Privacy Policy. You also agree to purchase the services indicated in this order form and authorize AllyDVM to activate your account.

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Accepted By
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First and Last Name Only
Today's Date

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MM/dd/yyyy

AllyDVM Order Form

Agree to Terms

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