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Boca General & Family Medicine New User Request Form
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Boca General & Family Medicine New User Request Form
Boca General & Family Medicine New User Submission Form
Fields marked with an
*
are required
First Name:
*
New Users First Name (this will be used for the username)
Last Name:
*
New Users Last Name (this will be used for the username)
Start Date:
When is the new user starting? If you don't have an exact date, please enter a tentative date.
Desired Email Address:
Computer:
*
No Computer
Existing Computer
New Computer (Please send Quote)
Applications:
Microsoft Office (Outlook, Word, Excel, etc)
Toshiba Faxing Client
Athena (Device Manager)
Printers:
Lab Printer (HP LaserJet M402n)
Reception Printer (Toshiba 3508A)
Setup 8x8 Phone Account:
*
Yes
No
Additional Notes About User
Your Email:
*
We will email you the credentials for the new user.
We will email you the credentials for the new user.
If you are a human seeing this field, please leave it empty.
Schedule a Call
Name
*
First
Email
*
Company Name
Phone
*
Phone
This field is for validation purposes and should be left unchanged.
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