Survey options Load unfinished survey Resume later You have completed 0% of this survey default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. IT Ticket Form 1 Please provide your name. 2 Enter your EPIC Username here without the @epichs.org/@epicpc.com 3 Please enter your email.This will provide you access to updates. This is a question help text. 4 For you or someone else? Choose one of the following answers Me Someone else 5 What is the role? Choose one of the following answers Please choose... Provider (SuperDoc/APP) Clinic staff (MA/MR/OA/BA) Outside of clinic (Non-clinical, Remote, Management) 6 Which location? Choose one of the following answers Please choose... Southfield 10 Mile Telegraph Ferndale Livernois Davision/Hamtramck Royal Oak Shores Clawson Eastpoint 7 Mile Westland HQ Flatworld Remote Worker 7 Please select a category and describe the issue to the best of your knowledge. Choose one of the following answers Please choose... Connection issue (wifi, RDP, account issue) Lab issue (not crossing over, labels not printing, not connecting to Apex) Printer issue (don't have it, won't print, not printing correctly) Computer issue (any computer: laptop, desktop/Thinkcentre) Point of Care device issue (Retinavue, ECG, Cognivue, Libreview, Tigerview, Spiro) HERO Other 8 Description of the issue Please provide any steps taken to resolve the issue or description of the issue. 9 Please add an image or file for troubleshooting if applicable. Please upload at most one file Upload file Title Comment File name Upload file Submit Load unfinished survey Resume later Exit and clear survey Exit and clear survey Please confirm you want to clear your response?