If you are a Non Corporate customer and would like to schedule either an Enterprise, EDIS or PIMS release, please fill out the form below. Submit your request at least fourteen (14) days in advance of the date you wish to install the release, be sure to include the time-of-day (24-hour format, CT) and after-hours contact information of the on-site person.
The MEDHOST Software Deployment Team will respond to your request within seven (7) days based on review of prerequisites and availability of time slots. Your requested date is tentative until confirmed by MEDHOST.
First Name
Last Name
Company
Email
Requested Install Date
Requested install time of day (24-hour-format) Use 24-hour format Central Time
Product to be installed EDISPIMSEnterprise
Requested Version
Comments