Point of Contact Name* (required) 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 Email address* (required) 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.
Practice Name* (required) Please enter the name of your practice
Physician Name* Please enter the name of the physician who is reporting this issue
Enhancement Title* (required) Please add a short title to describe the enhancement request
Enhancement Description* (required) Please describe the enhancement in as much detail as possible, using specific screen names, field names, etc.
Describe Impact* (required) 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.
Please attach screenshots of the request. If possible, mark-up the changes you’d like to make to a specific screen.
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