Cogmed order form

Welcome to the online Cogmed order form, we're
glad that you have chosen Cogmed!

To get started, let us know what type of setting you work in.

Organization type

Healthcare (clinics or institutions)Schools/Special Education (schools, districts, colleges/universities, educational support/tutoring companies)

Are you an existing Pearson Assessments customer?

Yes, I have a Pearson account#No

Pearson customer number

(Located on your invoice(s))

Pearson account name

Please tell us more about where you work

Clinic or Group Practice

Government

Hospitals

Medical, Therapy and Health Care

Private Practice/Solo Practice

Please tell us more about where you work

Early Childhood

K-12 Private School

K-12 Public School

Other Education-related

Other K-12 Schools and Education

Post-Secondary (College/University)

Cogmed purchase, renewal or update?

First time Cogmed purchaseRenewal or repeat Cogmed purchaseUpdate my existing Cogmed license (Add or manage coaches, sites)

Choose your Cogmed license type

Annual site license (year long access to Cogmed for coaches and trainees)Single use license (ability to use Cogmed with one trainee within a one year period)Note: Annual licenses are the best value for Cogmed coaches who will work with multiple Cogmed trainees each year.

First Time Cogmed Purchase

Each Clinical Cogmed account must have one qualified account owner who is responsible for managing the account and setting up other users (if applicable) on the account. The organizational administrator will be able to manage account settings in the Cogmed Coaching Center, such as the Find Provider map listing, languages served, and Telepractice settings.

First Name

Last Name

Phone number

Professional Title

if Other

Your license will begin as soon as your order is processed. If you need it to start on a specific date, please indicate below.

Annual license

Required License - Single Coach - $1100/annually
(login credentials may not be shared – each coach requires their own annual license)
Optional additional coach(es) - $880/each/annually

	Quantity	Price	ISBN
Cogmed Healthcare Annual Site License - Single Coach
Cogmed Healthcare - Additional Coaches Access

If you would like to order more than one annual site license, please call our customer support team at 1-800-627-7271 Option 6.

For each additional coach(es) requested, please provide their names and emails below:

First Name

Last Name

Single use license

Single Usage (ID) for one trainee - $350 each for one year access to complete training

	Quantity	Price	ISBN
Single ID pricing (use only if site license not ordered)

	Amount Due
Cogmed Healthcare Total

Each Cogmed School/Special Education account must have one qualified account owner who is responsible for setting up other users (if applicable) on the account. Up to 2 additional coaches are included in the $16500 annual fee. The organizational administrator will be able to manage account settings in the Cogmed Coaching Center, such as the Find Provider map listing, languages served, and Telepractice settings.

First Name

Last Name

Phone number

Professional Title

if Other

Your license will begin as soon as your order is processed. If you need it to start on a specific date, please indicate below.

Annual license

Up to 3 Coaches - $1650/annually (all coaches must be employed at the same school site)
Optional additional coach(es) - $880/each/annually

	Quantity	Price	ISBN
Cogmed School Annual Site License
Optional Additional Coaches

If you would like to order more than one annual site license, please call our customer support team at 1-800-627-7271 Option 6.

For each additional coach requested, please provide their names and emails below:

First Name

Last Name

Single use license

Single Usage (ID) for one trainee - $350 each for one year access to complete training

	Quantity	Price	ISBN
Cogmed Single Usage

	Amount Due
Cogmed School/Special Education Total

Clinical Cogmed Renewal Orders

Cogmed account name

(Located on top left of the Cogmed Coaching Center, or under Organization Settings from Coaching Center Menu)

Contact name

Contact phone number

Annual license

Required License - Single Coach - $1100/annually
(login credentials may not be shared – each coach requires their own annual license)
Optional additional coach(es) - $880/each/annually

	Quantity	Price	ISBN
Site License Renewal
Optional Additional Coaches

Single use license

Single Usage (ID) for one trainee - $350 each for one year access to complete training

	Quantity	Price	ISBN
Single Use License Renewal

	Amount Due
Cogmed Renewal Total

Do you need to make changes to your account with your renewal?

Please select from the following to renew your license

Add coach(es) to my existing licenseSuspend coaches from my existing licenseChange coaches in my existing license

Add coaches above to my renewal ($880 per additional coach annually)

For each additional coach requested, please provide their names and emails below:

First Name

Last Name

Remove/suspend coach(es) from my account
Please provide the names of the existing coach(es) you wish to remove:

First Name

Last Name

Change coaches in my account
You must remove a coach for every coach you wish to add or an additional coach license will be required.
Please provide the names of the existing coach(es) you wish to remove:

Coach(es) to
replace:

First Name

Last Name

Coach(es) to add:

First Name

Last Name

Schools/Special Education Cogmed Renewal Orders

Cogmed account name

(Located on top left of the Cogmed Coaching Center, or under Organization Settings from Coaching Center Menu)

Contact name

Contact phone number

Annual license

Required License - Single Coach - $1650/annually
(login credentials may not be shared – each coach requires their own annual license)
Optional additional coach(es) - $880/each/annually

	Quantity	Price	ISBN
Site License Renewal
Optional Additional Coaches

Single use license

Single Usage (ID) for one trainee - $350 each for one year access to complete training

	Quantity	Price	ISBN
Single Use License Renewal

	Amount Due
Cogmed Renewal Total

Do you need to make changes to your account with your renewal?

Please select from the following to renew your license

Add coach(es) to my existing licenseSuspend coaches from my existing licenseChange coaches in my existing license

Add coaches above to my renewal ($800 per additional coach annually)

For each additional coach requested, please provide their names and emails below:

First Name

Last Name

Remove/suspend coach(es) from my account
Please provide the names of the existing coach(es) you wish to remove:

First Name

Last Name

Coach(es) to
remove/suspend:

First Name

Last Name

Coach(es) to add:

First Name

Last Name

Clinical Update my existing license

Cogmed account name

(Located on top left of the Cogmed Coaching Center, or under Organization Settings from Coaching Center Menu)

Contact name

Contact phone number

Annual license

Required License - Single Coach - $1100/annually
(login credentials may not be shared – each coach requires their own annual license)
Optional additional coach(es) - $880/each/annually

Single use license

Single Usage (ID) for one trainee - $350 each for one year access to complete training

Please select from the following to update your license (choose one)

Add coach(es) to my existing licenseSuspend coaches from my existing licenseChange coaches in my existing license

Add coaches to my renewal
($880 per additional coach annually – this fee will be prorated based on the number of quarters remaining in your annual license – 25, 50, 75 or 100%)

How many users?

For each additional coach requested, please provide their names and emails below:

First Name

Last Name

Remove/suspend coach(es) from my account
Please provide the names of the existing coach(es) you wish to remove:

First Name

Last Name

Change coaches in my account

(you must remove a coach for every coach you wish to add or an additional coach license will be required)

Please provide the names of the existing coach(es) you wish to remove:

Coach(es) to
remove/suspend:

First Name

Last Name

Coach(es) to add:

First Name

Last Name

Special Education Update my existing license

Cogmed account name

(Located on top left of the Cogmed Coaching Center, or under Organization Settings from Coaching Center Menu)

Contact name

Contact phone number

Annual license

Required License - Single Coach - $1650/annually
(login credentials may not be shared – each coach requires their own annual license)
Optional additional coach(es) - $880/each/annually

Single use license

Single Usage (ID) for one trainee - $350 each for one year access to complete training

Please select from the following to update your license (choose one)

Add coach(es) to my existing licenseSuspend coaches from my existing licenseChange coaches in my existing license

Add coaches to my renewal
($880 per additional coach annually – this fee will be prorated based on the number of quarters remaining in your annual license – 25, 50, 75 or 100%)

How many users?

For each additional coach requested, please provide their names and emails below:

First Name

Last Name

Remove/suspend coach(es) from my account
Please provide the names of the existing coach(es) you wish to remove:

First Name

Last Name

Change coaches in my account

(you must remove a coach for every coach you wish to add or an additional coach license will be required)

Please provide the names of the existing coach(es) you wish to remove:

Coach(es) to
remove/suspend:

First Name

Last Name

Coach(es) to add:

First Name

Last Name

Bill to address

Street Address

Suite/Apartment

Building

Department Name

*Country

City

State

Zip/Postal Code

How would you like to pay?

PO #

Upload purchase order

Our customer support team will reach out to collect your credit card information.
Best time to call?

Mornings 7:00 AM - 12:00 PM CTAfternoons 12:00 - 6:00 PM CT

Contact phone number for credit card info

When would you like your invoice

Now On renewal date

TERMS

ANNUAL LICENSE

Additional users may be added during the term of the annual site license. Cost will be at the utilized user rate for the site license and prorated to the nearest full month.
A Cogmed license provides system access for both coaches and trainees for 1 year from the date of purchase. If longer access is required, the license must be renewed for continuing use of the system. Purchase of individual ID's also provides access for 1 year from the date of purchase for both coach and trainee.
Pearson Terms and Conditions of Sale and Use apply.

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Cogmed order form

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