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


Details of the Company and/or Person who will be calling the Additional Support Number 
 
 
 
Name of Company
 
 
Contact Name
 
 
 
After hours Phone No
 
 
Email
 
 
 
 
 
 
The Call will not be attended if it falls outside of the booking date and times below:
 
Date for Additional Support
 
 
 
 
Start Time
 
 
End Time
 
 
 

 
 
 
 
Reason for Additional Support
 
Server Migration
Database Maintenance
Upgrade / Installation
 
 
 
Other (please specify)
 
 
 
 
 
 
 
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 about to provide any of the above resources after hours.
 

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



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