Synergy Medical HelpDesk IT Form
Use this form to request support or new equipment from our IT department
Name
Email
Alternative Email
Service type
Network
Software
Hardware
Office 365
Email
Other:
Comments
Special Instructions or Needs
Where are you working from?
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
Employee Location
(if 'other' please specify in comments)
Main Office
Clinic Location
Synergy Labs
Other
Work Phone
Alternate Phone
Date Of Request
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