IT Ticket Submission - Convergent Dx

IT Support Ticket Submission
*please refrain from including PHI in this ticket request. If PHI is needed for technical purposes, please note this in the ticket description, and a staff member will reach out for the requisite details.
Name

First NameLast Name
Email*
first.last@kdlpathology.com
Phone Number
Please enter a valid phone number.
Lab Location
Please describe your issue.*
Please be as detailed as possible, while ensuring not to include any PHI.
Date

YearMonthDay
Hour MinutesAM/PM Option
Time

Hour Minutes

AM/PM Option
Please verify that you are human*
Should be Empty:

IT Support Ticket Submission