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PRACTICE INFORMATION
Practice Name:
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Contact Name:
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Contact phone:
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Contact Email Address:
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Services Purchased:*
 Clinical Management - $2,400 Annually per Physician
 Practice Management - $3,000 Annually per Physician
Number of Physicians to be Contracted:
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SandsEMR PAYMENT AUTHORIZATION
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CONTRACT INFORMATION
Effective Month:
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Effective Day:*
 15th
 30th
Term of Contract:*
 1 Year
 3 Year
10% discount on monthly fees and $250 Activation Fee with 3 year contract
   
SandsEMR TERMS OF SERVICE AGREEMENT AND ACCEPTANCE
SandsEMR TERMS OF SERVICE A. SandsEMR GENERAL TERMS OF SERVICE.
   Thank you for selecting the Services offered by SandsEMR or its Affiliates (referred to as "SandsEMR", "we", "our", or "us") on this website. Please review these Terms of Service ("Agreement") thoroughly. This Agreement is a legal agreement between you and SandsEMR. By clicking "I AGREE," indicating acceptance electronically, accessing or using the Services, you agree to these terms. If you do not agree to this Agreement, then do not indicate acceptance of the Agreement, and do not use the Services.
1. AGREEMENT 1.1 This Agreement describes the terms governing your use of the SandsEMR online services provided to you on this website, including content, updates and new releases, (collectively, the "Services"). It includes by reference: SandsEMR's Privacy Statement available on this website or provided to you in writing for the Services you selected. Additional Terms and Conditions for the Services that you have selected, including from third parties. Third Party Privacy Statement provided to you in writing for the Services you selected. Any terms provided separately to you for the Services, including for example, billing services or program terms, ordering, activation, pricing and payment terms, if applicable, for the Services. 1.2 An "Affiliate" means all companies and subsidiaries that directly or indirectly, control the SandsEMR product. As used in this Agreement, control means equity ownership of fifty percent (50%) or greater interest in the voting shares held by an entity. 2. YOUR RIGHTS TO USE THE SERVICES AND RESTRICTIONS 2.1 The Services are protected by copyright, trade secret, and other intellectual property laws. You are only granted the right to use the Services, and SandsEMR reserves all rights of ownership in the Services not granted to you in writing here. As long as you meet any applicable payment obligations and comply with this Agreement, SandsEMR grants to you a personal, limited, nonexclusive, nontransferable right to use the Services that is valid only for the period of use provided in the ordering and activation terms, and only for the purposes described by SandsEMR on the website for the Services. 2.2 You agree not to use the Services or content on this website in a manner that violates any applicable law, regulation or this Agreement. For example, unless authorized by SandsEMR in writing, you agree you will not: Provide access to or give any part of the Services to any third party. Reproduce, duplicate, copy, deconstruct, sell, trade or resell the Services. Attempt to access any other SandsEMR systems that are not part of these Services. Excessively overload the SandsEMR systems used to provide the Services. If you violate any of these terms, this Agreement and your right to use the Services may be terminated by SandsEMR in its sole discretion. 3.PAYMENT.
For Services offered on a payment or subscription basis, the following terms apply, unless SandsEMR notifies you otherwise in writing. This Agreement also incorporates by reference and includes program ordering and payment terms provided to you on the website for the Services:
   a. Payments will be billed to you in U.S. dollars, and your account will be debited when you subscribe and provide your payment information, unless stated otherwise in the program ordering or payment terms on the website for the Services.
   b. You must pay with one of the following:
  1. A valid credit card acceptable to SandsEMR;   2. A valid debit card acceptable to SandsEMR;   3. Sufficient funds in a checking or savings account to cover an electronic debit of the payment due; or   4. By another payment option SandsEMR provides to you in writing.    c. If your payment and registration information is not accurate, current, and complete and you do not notify us promptly when such information changes, we may suspend or terminate your account and refuse any use of the Services.    d. SandsEMR will automatically renew your monthly or annual Services at the current rates, unless the Services are cancelled or terminated under this Agreement.    e. Additional cancellation or renewal terms may be provided to you on the website for the Services. 4.TRIAL PERIOD.
If you registered for a trial use of the Services ("Trial Period"), you must decide to purchase the Services within the Trial Period in order to retain any Content (defined in Section 6) that you have posted or uploaded during the Trial Period. If you do not purchase the Services or products by the end of the Trial Period, your Content will no longer be available to you. To be very clear, after using the Services or product during the trial period, if you decide not to purchase the full version of the Services, you will not be able to access or retrieve any of the data you added/created during the trial. 5. YOUR PRIVACY AND PERSONAL INFORMATION.
You can view SandsEMR's Privacy Statement on the SandsEMR website, or via a link on the website for the Services you have selected. You agree to be bound by the applicable SandsEMR Privacy Statement, subject to change in accordance with its terms. Most importantly, you agree: - To SandsEMR maintaining your data according to the SandsEMR Privacy Statement, as part of the Services. - To give SandsEMR permission to aggregate your non-personally identifiable data which you enter or upload with that of other users of the Service. By way of example, this means that SandsEMR may use that aggregated data to improve services, design promotions, or provide ways for you to compare business practices with other users. SandsEMR is a global company and may access or store personal information in multiple countries, including countries outside of the European Union that may be deemed to have inadequate protections by European Union Data Protection Authorities. When you agree to these Terms of Service, you agree to this practice. 6. CONTENT
6.1 You are responsible for your content. You are legally responsible for all information, data, text, software, music, sound, photographs, graphics, video, messages or other materials ("Content") uploaded, posted or stored through your use of the Services. You grant SandsEMR a worldwide, royalty-free, non-exclusive license to host and use the Content in order to provide you with the Services. You agree not use the Services for any illegal purpose or in violation of any applicable local, state, federal or international law. You are encouraged to archive your Content regularly and frequently. You are responsible for any Content that may be lost or unrecoverable through your use of the Services. You must provide all required and appropriate warnings, information and disclosure. You agree that you will not use the Services to share, store, or in any way distribute financial data that is not in accordance with the law. Any users suspected of having information which involves fraud, embezzlement, money laundering, insider trading, support for terrorism, or any other activity proscribed by law may have their accounts terminated, their financial data erased, and they also may be reported to law enforcement officials in the appropriate jurisdictions. SandsEMR is not responsible for the Content or data you submit on the website. You agree not to use the Services to upload, post, distribute, link to, publish, reproduce, engage in or transmit any of the following, including but not limited to:
a. Illegal, fraudulent, libelous, defamatory, obscene, pornographic, profane, threatening, abusive, hateful, harassing , offensive, inappropriate or objectionable information or communications of any kind, including without limitation conduct that would encourage or constitute an attack or "flaming" others, or criminal or civil liability under any local, state, federal or foreign law;
b. Content or data that would impersonate someone else or falsely represent your identity or qualifications, or that constitutes a breach of any individual's privacy, including posting images about children or any third party without their consent (or a parent's consent in the case of a minor);
c. Except as otherwise permitted by SandsEMR in writing, advertisements, solicitations, investment opportunities, chain letters, pyramid schemes, other unsolicited commercial communication or engage in spamming or flooding;
d. Virus, trojan horse, worm or other disruptive or harmful software or data; and
e. Any information, software or Content which is not legally yours and may be protected by copyright or other proprietary right, or derivative works, without permission from the copyright owner or intellectual property rights owner. 6.2 Community forums. The Services may include a community forum to exchange information with other users of the Services and the public. Please use respect when you interact with other users. SandsEMR does not support and is not responsible for the accuracy of others' content in these community forums. Do not reveal information in the community forum that you do not want to make public. Users may post hypertext links to content hosted and maintained by third parties for which SandsEMR is not responsible.
6.3 SandsEMR may freely use feedback you provide. You agree that SandsEMR may use your feedback, suggestions, or ideas in any way, including in future modifications of the Services, other products or services, advertising or marketing materials. You grant SandsEMR a perpetual, worldwide, fully transferable, sublicensable, irrevocable, fully paid-up, royalty free license to use the feedback you provide to SandsEMR in any way. SandsEMR will not sell, publish or share your feedback in a way that could identify you without your explicit permission.
6.4 SandsEMR may monitor your content from time to time. SandsEMR may, but has no obligation to, monitor content on the Services. We may disclose any information necessary or appropriate to satisfy our legal obligations, protect SandsEMR or its customers, or operate the Services properly. SandsEMR, in its sole discretion, may refuse to post, remove, or refuse to remove, any Content, in whole or in part, alleged to be unacceptable, undesirable, inappropriate, or in violation of this Agreement.
7. ADDITIONAL TERMS YOU AGREE TO
7.1 SandsEMR does not give professional advice. SandsEMR is not in the business of providing legal, financial, accounting, health care, or other professional services or advice. Consult the services of a competent professional when you need this type of assistance.
7.2 SandsEMR Services. You may be offered other services, features, products, applications, online communities, or promotions provided by SandsEMR ("SandsEMR Services"). If you decide to use any of these SandsEMR Services or products, additional terms and conditions and separate fees may apply. You acknowledge that in accessing some SandsEMR Services you may upload or enter data such as names, addresses and phone numbers, purchases, and other data to the Internet. You grant SandsEMR permission to use information you provide and about your experience so that we can provide the SandsEMR Services to you, monitor and analyze your use of the services, maintain and update your data, and address errors or service interruptions. We may use this data to improve services, enhance future services, identify potentially relevant offers, and produce anonymous research data. You grant SandsEMR permission to combine the data you have entered or uploaded with that of others in a way that does not identify you or any individual personally. You also grant SandsEMR permission to share or publish summary results relating to such research data and to distribute or license such data to third parties. 7.3 We may tell you about third party products or services. Subject to the SandsEMR Privacy Statement, SandsEMR may offer products and services on behalf of third parties who are not affiliated with SandsEMR ("Third Party Products") or the Services may contain links to third party websites ("Third Party Sites").You agree that SandsEMR can use your contact information, including name and address, for the purpose of offering these products to you in accordance with your stated SandsEMR contact preferences. If you decide to use any Third Party Products or access any Third Party Sites, you are responsible for reviewing the third party's separate product terms, website terms and privacy policies. You agree that the third parties, and not SandsEMR, are responsible for their product's performance and the content on their websites. SandsEMR is not affiliated with these Third Party Products or Third Party Sites and has no liability for them 7.4 Communications choices. SandsEMR may be required by law to send you communications about the Services or Third Party Products. You agree that SandsEMR may send these communications to you via email or by posting them on one of our sponsored websites. We may also send business communications such as confirmations or notices that will be delivered to you via email or posted on our websites. You are required to receive these communications. You can choose not to receive some types of communication, such as marketing. Please review the Privacy Statement or follow instructions on the communication. 7.5 You will track your passwords and accept updates. You are responsible for securely managing your password(s) for access to the Services. If you become aware of any unauthorized access to your Services account, theft or loss of your password, you agree to contact SandsEMR as soon as possible. The Services may periodically be updated with tools, utilities, improvements, third party applications, or general updates to improve and enhance the features and performance of the Services. You agree to receive these updates automatically as part of the Services. 8. DISCLAIMER OF WARRANTIES
8.1 YOUR USE OF THE SERVICES, SOFTWARE, AND CONTENT IS ENTIRELY AT YOUR OWN RISK. EXCEPT AS DESCRIBED IN THIS AGREEMENT, THE SERVICES ARE PROVIDED "AS IS." TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, SANDSEMR, ITS AFFILIATES, AND ITS THIRD PARTY SERVICE OR DATA PROVIDERS, LICENSORS, DISTRIBUTORS OR SUPPLIERS (COLLECTIVELY REFERRED TO AS, "SUPPLIERS") DISCLAIM ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING ANY WARRANTY THAT THE SERVICES ARE FIT FOR A PARTICULAR PURPOSE, TITLE, MERCHANTABILITY, DATA LOSS, NON-INTERFERENCE WITH OR NON-INFRINGEMENT OF ANY INTELLECTUAL PROPERTY RIGHTS, OR THE ACCURACY, RELIABILITY, QUALITY OR CONTENT IN OR LINKED TO THE SERVICES. SANDSEMR AND ITS AFFILIATES AND SUPPLIERS DO NOT WARRANT THAT THE SERVICES ARE SECURE, FREE FROM BUGS, VIRUSES, INTERRUPTION, ERRORS, THEFT OR DESTRUCTION. IF THE EXCLUSIONS FOR IMPLIED WARRANTIES DO NOT APPLY TO YOU, ANY IMPLIED WARRANTIES ARE LIMITED TO 60 DAYS FROM THE DATE OF PURCHASE OR DELIVERY OF THE SERVICES, WHICHEVER IS SOONER. 8.2 SANDSEMR AND ITS AFFILIATES AND SUPPLIERS DISCLAIM ANY REPRESENTATIONS OR WARRANTIES THAT YOUR USE OF THE SERVICES WILL SATISFY OR ENSURE COMPLIANCE WITH ANY LEGAL OBLIGATIONS OR LAWS OR REGULATIONS. THIS DISCLAIMER APPLIES TO BUT IS NOT LIMITED TO THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 ("HIPAA"), THE GRAMM-LEACH-BLILEY ACT OF 1999, THE SARBANES-OXLEY ACT OF 2002, OR OTHER FEDERAL OR STATE STATUTES OR REGULATIONS. YOU ARE SOLELY RESPONSIBLE FOR ENSURING THAT YOUR USE OF THE SERVICES IS IN ACCORDANCE WITH APPLICABLE LAW. 9. LIMITATION OF LIABILITY AND INDEMNITY.
TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, THE ENTIRE LIABILITY OF SANDSEMR, AND ITS AFFILIATES AND SUPPLIERS FOR ALL MATTERS OR CLAIMS RELATING TO THIS AGREEMENT SHALL BE LIMITED TO THE AMOUNT YOU PAID FOR THE SERVICES DURING THE TWELVE (12) MONTHS PRIOR TO SUCH CLAIM. SUBJECT TO APPLICABLE LAW, SANDSEMR AND ITS AFFILIATES AND SUPPLIERS ARE NOT LIABLE FOR ANY OF THE FOLLOWING: (A) INDIRECT, SPECIAL, INCIDENTAL, PUNITIVE OR CONSEQUENTIAL DAMAGES; (B) DAMAGES RELATING TO FAILURES OF TELECOMMUNICATIONS, THE INTERNET, ELECTRONIC COMMUNICATIONS, CORRUPTION, SECURITY, LOSS OR THEFT OF DATA, VIRUSES, SPYWARE, LOSS OF BUSINESS, REVENUE, PROFITS OR INVESTMENT, OR USE OF SOFTWARE OR HARDWARE THAT DOES NOT MEET SANDSEMR SYSTEMS REQUIREMENTS. THE ABOVE LIMITATIONS APPLY EVEN IF SANDSEMR AND ITS AFFILIATES AND SUPPLIERS HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. THIS AGREEMENT SETS FORTH THE ENTIRE LIABILITY OF SANDSEMR, ITS AFFILIATES AND YOUR EXCLUSIVE REMEDY WITH RESPECT TO THE SERVICES AND ITS USE. You agree to indemnify and hold SandsEMR and its Affiliates and Suppliers harmless from any and all claims, liability and expenses, including reasonable attorneys' fees and costs, arising out of your use of the Services or breach of this Agreement (collectively referred to as "Claims"). SandsEMR reserves the right, in its sole discretion and at its own expense, to assume the exclusive defense and control of any Claims. You agree to reasonably cooperate as requested by SandsEMR in the defense of any Claims. 10. CHANGES TO THIS AGREEMENT OR THE SERVICES. We may change this Agreement from time to time, and the changes will be effective when posted on our website for the Services or when we notify you by other means. Please review the Agreement periodically on this website for changes. We have the right to change any of the terms of this Agreement upon reasonable notice to you. We may also change or discontinue the Services, in whole or in part, including but not limited to, the Internet based services, pricing, technical support options, and other product-related policies. Your continued use of the Services after SandsEMR posts or otherwise notifies you of any changes, indicates your agreement to the changes. 11. TERMINATION.
SandsEMR may immediately and without notice terminate this Agreement or suspend the Services provided to you, if you fail to comply with these terms or if you no longer agree to receive electronic communications (see Section 7.4). Upon termination you must immediately stop using the Services and any outstanding payments will become due. Any termination of this Agreement shall not affect SandsEMR's rights to any payments due to it. SandsEMR may terminate a free account at any time. Other requirements regarding termination or cancellation of the Services may apply based on the specific ordering terms for the Services provided to you. Sections 1.2, 5, 8 through 15 will survive and remain in effect even if the Agreement is terminated, cancelled or rescinded. 12. EXPORT RESTRICTIONS.
You acknowledge that this website, the Services, and the underlying software may include U.S. technical data subject to restrictions under export control laws and regulations administered by the United States government. You agree that you will comply with these laws and regulations, and will not export or re-export the Services, or any part of the Services, in violation of these laws and regulations, directly or indirectly. You also agree not to provide access to any part of the Services to anyone who you have reason to know may use the Services in the development of nuclear, chemical, or biological weapons. 13. GOVERNING LAW AND URISDICTION.
Texas state law governs this Agreement without regard to its conflicts of laws provisions. To resolve any legal dispute arising from this Agreement, you and SandsEMR agree to the exclusive jurisdiction of state courts in The Woodlands, Texas U.S.A. or federal court for the South Eastern District of Texas. SandsEMR does not represent that information on the website for the Services is appropriate or available for use in all countries. SandsEMR prohibits accessing materials from countries or states where contents are illegal. You are accessing this website on your own initiative and you are responsible for compliance with all applicable laws. 14. HIPAA COMPLIANCE.
The parties agree to comply with the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, as amended and any and all regulations promulgated there under (collectively "HIPAA"). The parties further agree to comply with the Health Insurance Technology for Economics and Clinical Health Act (HITECH Act) of 2009, PUB. L. No. 111-5. 15. MEANINGFUL USE VERIFICATION.
If you seek to secure HITECH Incentive Payments as a Medicare or Medicaid EMR user, you are responsible for reporting or attesting to your compliance with the applicable Meaningful Use reporting requirements. 16. LANGUAGE.
Any translation of this Agreement is done for local requirements and in the event of a dispute between the English and any non-English version, the English version of this Agreement shall govern. The parties hereby confirm that they have requested that this Agreement and all related documents be drafted in English. Les parties ont exige que le present contrat et tous les documents connexes soient rediges en anglais. 17. GENERAL. This Agreement is the entire agreement between you and SandsEMR and replaces all prior understandings, communications and agreements, oral or written, regarding its subject matter. This Agreement may be modified only by a written amendment signed by the parties or as provided in this Agreement in Section 10 above. If any court of law, having the jurisdiction, rules that any part of this Agreement is invalid, that section will be removed without affecting the remainder of the Agreement. The remaining terms will be valid and enforceable. The United Nations Convention on Contracts for the International Sale of Goods does not apply to this Agreement. You cannot assign or transfer ownership of this Agreement to anyone without the prior written approval of SandsEMR. However, SandsEMR may assign or transfer it without your consent to (a) an Affiliate, (b) another company through a sale of assets by SandsEMR or (c) a successor by merger. Any assignment in violation of this Section shall be void. If you want to request a transfer of this Agreement or if your company is acquired by or merged into another company, contact SandsEMR via an email to: info@goldsandssolutions.com.

 By checking this box, I understand and accept the terms setforth in this Agreement and confirm that I am authorized to accept these terms. I further authorize a Gold Sands Solutions' representative to implement the SandsEMR product on behalf of the Physician Practice. I authorizes Gold Sands Solutions to debit and credit entries to the above credit card or bank account. I acknowledges that the origination of the transactions to the above credit card or bank account must comply with the provision of the U.S. law.

Electronic Signature : Dated :