Please use this form to record the approximate duration of a slow down in Medisked or an instance where you saved information but it was lost. A comment is not required unless "Other" is chosen for the category or location.

Note: This system is solely for information gathering. No tickets will be created and no other notification will occur from this.

Date/Time*:
Category*:
Location*:
Duration (seconds):


Approximately how long did you have to wait?
This is a numeric field, so please enter numbers only.
Comments:
Click to attach a saved file (e.g. a screen shot image) ------>





*Indicates required field