Additional Support Request Form
Practice/Organisation: *
Customer ID:*
First Name:*
Last Name:*
Phone Number*
Email Address:*

Your Preferred Date and Start Time for Additional Support
Date for Additional Support
Preferred Start Time:

Reason for Additional Support
Server Migration
Database Maintenance
Upgrade / Installation
Other (please specify)
PLEASE NOTE: Ensure that the practice has all the required setup files including, CD\DVD, update patches, registrations, keys/activation details, release notes and instructions organised and ready during office hours. Medtech Staff will not be available to provide any of the above resources after hours.

Our Additional Support Rates are as follows (Timings are subjected to availability)

Monday to Friday: 8:00am to 5:00pm AEST = $150+GST per hour
Monday to Friday: 5:00pm to 9:00pm AEST = $200+GST per hour

By submitting the form, I confirm to have legal authority to accept liability for the practice or have obtained consent from the practice's management to act on behalf of the practice.
Privacy Policy*
I have read and accept the Privacy Policy and I am authorised to make this commitment on behalf of my organisation.
         See Privacy Policy