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Technical Support Request
Name
First Name
Last Name
Email
example@example.com
Which location does this request apply to?
NMCC
WACC
Both
What best describes the primary reason for the request
Login and Password
Patient Missing or Not Visible
Scheduling and Calendar Issue
Company Email
Invoice Issue
Sharing Document
Treatment Plan Signature
Supervision Notes or Records
Adding Contact to Patient File
Client Assignment
File Access
Gusto
Facility Maintenance
Service Report Only - No Request
Other
Please describe your unique need
Please describe the work performed
Please upload Screenshots if necessary (Do not include screenshots with PHI)
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