Demonstration Registration

To view the interactive demonstration of the full PAERS Medical Records System please fill in and submit the form below. A password will be emailed to your email address immediately the form is submitted.

Title:
First Name:
Surname:
Password:
Re-enter Password:
Valid Email Address:
Re-enter Email Address:
Telephone Number:
Organisation:
Follow up Contact by Email:
Follow up Contact by Telephone:

The information submitted using this form will not be released or be used by any third party and will only be used by us to follow up your interest in PAERS.