Support Request
UltraMED Login Name:
(or put none)
*
Name:
*
Company:
*
Phone:
*
Email:
UltraMED Staff Requested:
Category:
Support - UltraMED
Support - UltraEMR
Support - UltraMED Billing Service
Support - Connection
Sales - UltraMED
Sales - UltraEMR
Sales - Custom Forms (for EMR)
Sales - UltraMED Billing Service
E-Prescription/PQRI
Recommended Equipment
Electronic Statements
Scanning Old Charts
Palmetto
Clearinghouse
Billing
Misc
Subject:
*
Detailed Description:
(
*
= required field)