AARA - AARA CareCloud Enhancement Request Form AARA

AARA CareCloud Enhancement Request Form

Instructions: Please enter your enhancement request into this form. This form is ONLY for enhancements. Please contact CareCloud Support or your Account Manager (as appropriate for your office’s service level) with system bugs, system performance concerns, training requests, configuration change requests, billing questions, etc.

1. Please enter the full name for the main point of contact. This should be the person we can contact for clarification and follow-up questions.

Point of Contact Name* (required)

2. Please enter the email address for the main point of contact. This should be the person we can contact for clarification and follow-up questions.

Point of Contact Email address* (required)

3. Please enter the name of your practice.

Practice Name* (required)

4. Please enter the name of the physician who is reporting this issue.

Physician Name* (required)

5. Please select the enhancement request.

Enhancement Request* (required)

6. Please describe the enhancement in as much detail as possible, using specific screen names, field names, etc.

Enhancement Description* (required)

7. Please describe the impact to your practice of the current CareCloud system design (workflow, patients, revenue, liability concerns, etc.). Please provide as much detail as possible as it aids us in prioritization.

Describe Impact* (required)

Screenshots: Please attach screenshots of the request.

If possible, mark-up the changes you’d like to make to a specific screen

Upload File 1

Upload File 2

Upload File 3

Upload File 4

Upload File 5