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Cerbo Integrated Ticket

One Line Issue Description(Required)

Practice Info

Medical Practice(Required)

Cerbo Admin URL(Required)

Example practicename.md-hq.com

Name(Required)

First Last

Email(Required)

Ticket Info

Level of Urgency(Required)

Mild

Warm

Hot

Application(Required)

Select the Application that your ticket is associated with.

Application Other

Loom - Video of Issue

Is This an Update to a Prior Ticket(Required)

Yes

No

Ticket Number

Details of Event(Required)

File Upload

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.

Date Cerbo Event

Month

Day

Year

Cerbo Event ID

Cerbo PT ID Associated with event

Team Members you want part of this ticket

Name

Email

Phone

Hidden

ticket_type

Video Support ?(Required)

Yes

No

Do you want to connect for a Video Support

Integration Level

Integration Level(Required)

Basic

Pro

Elite

Enterprise

Basic Video Support(Required)

15 Min Connection - non-technical

45 Min Paid

Basic Video Support Options

Pro Video Support(Required)

30 Min Support

Pro Video Support Options

Elite Video Support(Required)

30 Min Support

60 Min Support

Elite Video Support Options

Enterprise Video Support(Required)

15 Min Support

30 Min Support

60 Min Support

Enterprise Video Support Options

Friday Connection Questions

Newsletter Sign-up

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Friday Connection Questions

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Newsletter Sign-up

Name

First Last

Email

Email

Medical Practice

What is next year date? xxxx(Required)

Please enter a number from 2024 to 2024.

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