Name *

Email address *

Clinic *

User Group *

Healthcare Provider
TeleSonographer
TeleScan Operator
TeleScan Admin
Other

Customer Impact and Business Urgency*

Major - Patient care is blocked. Immediate assistance is needed.
Significant - Patient care is slow or delayed. Assistance is needed to restore to normal.
Moderate - Patient care is normal, but with workarounds.
Other - Question
Other - Feature Request

Description *

Workaround

Upload a video

Upload or Paste Images

Submit Request