360neo Setup Request

1.General request information

Tell us who you are and which 360neo solution this request is for.

Who is completing this form?

MagVenture employee Customer / end user

Please choose one.

Your name

Please enter your name.

Your email

Your confirmation and request number go here.

Please enter a valid email address.

Customer / clinic name

Please enter the customer or clinic name.

Has the customer already purchased a 360neo solution?

Yes No

Please choose one.

Which 360neo solution is the request for?

360neo Basic Clinic information only — the details needed to create the clinic. 360neo Pro Cloud-hosted. Also asks for setup contacts and email configuration. 360neo Enterprise Described in your own words — we will follow up individually.

Please select a 360neo solution.

2.Clinic information

This is the information needed to create the clinic setup in 360neo.

Clinic logooptional

PNG or JPG, up to 2 MB. Drag a file here or use the button.

Please choose a PNG or JPG image under 2 MB.

Clinic name

Prefilled from above — edit it if the registered clinic name differs.

Please enter the clinic name.

Descriptionoptional

A short description of the clinic.

Tax ID / VAT number

Or the local equivalent for the clinic/company.

Please enter the tax ID or VAT number.

Address

Please enter the street address.

City

Please enter the city.

State / Region

Please enter the state or region.

ZIP / Postal code

Please enter the ZIP or postal code.

Country

Please select the country.

Phone number

Please enter a phone number.

Clinic email

Please enter a valid clinic email address.

Websiteoptional

That does not look like a valid web address.

3.Pro / Cloud setup information

360neo Pro is cloud-hosted. Rather than asking you to make technical infrastructure decisions, we just need to know who to talk to during setup.

Primary contact for the 360neo setup

The person we can contact about the setup overall.

Contact name

Please enter the primary contact's name.

Email

Please enter a valid email address.

Phone number

Please enter a phone number.

Clinic IT contact

Optional, but please complete it if you can — this is who X-Apps or MagVenture contacts if technical information is needed during deployment.

IT contact nameoptional

IT contact emailoptional

Please enter a valid email address.

IT contact phoneoptional

4.Email / SMTP configuration

360neo may need to send emails. If the clinic requires its own email configuration, we need to set it up deliberately rather than partially.

Does the clinic need to use its own SMTP / email configuration?

Yes No Not sure

Please choose one.

2.360neo Enterprise

Enterprise setups are discussed individually, so tell us what you need in your own words and we will follow up.

Please describe the requested Enterprise setup / configuration

Please describe the setup you need.

Additional comments / requirementsoptional

→Submit your request

How we use this information. MagVenture uses the details above only to create and support the requested 360neo setup, and shares them with our cloud partner where a Pro or Enterprise deployment requires it. We do not use them for marketing.

Please complete the human verification check.

You will receive a confirmation email with your request number.

360neo Setup Request

Please check the form

1.General request information

2.Clinic information

3.Pro / Cloud setup information

Primary contact for the 360neo setup

Clinic IT contact

4.Email / SMTP configuration

Person who can provide the SMTP configuration

2.360neo Enterprise

→Submit your request

Thank you — your request has been received