Technical Support Request Form

If you have an inquiry of a non-emergency nature, you may fill out the form below and our staff will respond within two business days. Fields notated with an asterisk ( * ) are required.

Note: If you have questions about how LSS uses your information, please review our Privacy Policy before proceeding.

Contact Information
*Company Name:
Company Code:
Facility #:
*Your Name:
*Email:
*Phone:
Fax:
Preferred method of contact?

Request Type(s) Check all that apply...
	Program Error - PLEASE CONTACT US BY PHONE WHEN REPORTING PROGRAM ERRORS Error Code: Line #: Program:
	Software Defect (i.e., a replicable flaw in the operation of the software)
	Installation (i.e., scheduling an install, installation fails)
	Feature Request
	Functional (i.e., something should work but doesn't)
	Printing (i.e., printouts inaccurate) Printer Make: Printer Model:
	Data Corruption (i.e., software appears to operate correctly but data indicates otherwise)
	General Usage (i.e., how to do something)

Affected Feature(s) Please indicate which module(s) and program(s) you are contacting us about.
Module (i.e., Health Center Billing):
Program (i.e., Enter Resident Charges):

Details Please provide a complete description of the problem or question you have.

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