IT SUPPORT TICKET
Your Name:
*
Office/Client Name:
*
Phone:
*
Email: (Used for Ticket Notifications)
example@example.com
Issue Type:
*
Please Select
Computer Issue
Printer Issue
Phone/Internet Issue
Not Receiving Results
EMR Interface Issue
Portal Issue
Password Reset / Locked Out
Other (Explain Below)
Priority:
*
Please Select
Low
Medium
High
Critical
Description of Issue:
*
Submit Ticket
Should be Empty: