» Triangle Eye – Submit a Ticket

Information of requester

Your Name*

First Last

Your Email*

Enter Email Confirm Email

Is this request for you or on the behalf of someone else?

Self
Another User

What can we help you with today?*

Medical Equipment
New Workstation
Workstation Issue
New Access Request
Printer/Scanner Issue
Other

Name of User

First Last

Email of User

What can we help you with today?*

Medical Equipment
New Workstation
Workstation Issue
New Access Request
Printer/Scanner Issue
Other

New Access Request

What access is being requested?

Select All
Computer Login
Email

Name of User*

First Last

User to copy credentials from*

Printer/Scanner Issue

Which Location is this for?*

Bakersfield
Delano

Which printer is having the issue?*

Reception
Medical Records
Administration

Workstation being used?*

Briefly describe the issue.*

Other Issue

Which location is this for?*

Bakersfield
Delano

Briefly explain what you need help with.*

Workstation Issue

Which location is this for?

Bakersfield
Delano

What seems to be the issue with your workstation?*

Please describe the issue*

New Workstation

What software will need to be installed?*

Additional Software (if any)

Will the new workstation need any peripherals?*

Yes
No

What will this computer require?

Select All
Monitor
Mouse
Keyboard

Medical Equipment

Which location is this for?*

Bakersfield
Delano

Which Piece of equipment is experiencing issues?*

Konan
3D OCT

Briefly describe the issue.*

Best way to contact you

What is the best way to contact you?*

Company Phone
Email
Cell Phone

Cell Phone Number*

Ext.