This form should be used by Medisoft and Medisoft Clinical EMR clients to request one-time technical support for those products. It may also be used to request general IT support for non-managed clients. In all cases, a minimum one-hour charge of $125.00 will apply. If repair or support requires more than an hour, time will be billed at the same rate ($125.00/hour). Please select the type of support you require from the drop-down menu, provide as many details as possible, and complete the credit card authorization portion of this form. No credit card information will be maintained on this website; it will transfer to Authorize.net for secure card processing. Upon receipt of your fully completed form, we will contact you to schedule service.
Please Note: If you are a Managed Services client, see instructions at right.