Right Choice Technologies, Inc.
Support Request Form
Contact Name:
Practice Name:
Office location
(if practice is multi-site):
Contact phone
(including area code) :
Contact email address
(how we will contact you):
Computer Name / ID
(ex. WS001, PC01, HP001):
Public IP Address
(use www.myipaddress.com):
Please provide the following information:
Problem type:
Please select
Cosmetic
Crash
Data loss
Failure
Feature request
General question
Performance issue
Training
Windows
Tablet
Workstation
Server
Laptop
Wireless
Scanner
Printer
Backup
Monitor
Operating system:
Please select
Windows NT4
Windows 2000
Windows XP
Software version number:
(To find the version number, click on the Help Menu and choose About.)
Problem description:
Enter a description of the problem. Please include information such as when the problem started, how long it has been occurring, how often does it happen and anything else relevant to the problem.