HIFIS Service Request Form

Please consult with your SuperUser / Supervisor about this services request before completing the form. Thank you.

Notes:
  • Only requests submitted on this form will be considered.
  • The HIFIS team will review the requests every three months.
  • Suggestions will be prioritized based on the likelihood that changes would result in a positive experience / change for multiple organizations or users.
  • SuperUsers / Supervisors are responsible for requesting system changes on behalf of their organization.
  • A written response to your request will be provided.


1.
2.
*Service Provider:
3.
Email or Phone Number
4.
HIFIS User Type
5.
What is your service request?
6.
*Change Request or Suggestions:
Please consult with your supervisor about this change request before completing the form.
7.
*Reason for Service Request:
8.
Attachments or References (OPTIONAL):