Please provide the name of your parent organization or local office.
10-digit phone number a customer would call to contact the specific office location (Preferred CONTACT info can be left in the DESCRIPTION field) [Numbers only, no spaces or punctuation ~ Ex: "8005551234" NOT "800-555-1234"]
If you are requesting a callback, please enter a phone number where you can best be reached.
Select the Apteryx product(s) associated with the issue. (Can select multiple options)
If your location subscribes to our cloud-based imaging product, please copy and paste your current browser address (it will look like this https://SITENAME.xvweb.net where SITENAME is your practice name)
What imaging hardware (sensor/pan/scanner/etc) is related to the issue? [Please provide brand and type]
Software Registration Number(s) or Hardware Serial Number(s) (Maximum of 8 Reg Numbers or 32 Serial Numbers) [Separate multiple numbers by commas (,) & format Reg Numbers with dashes (-) every 4 characters]
Please enter the details of your request. A member of our support staff will respond as soon as possible.
