Additional Support Request Form
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
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