PCMH Assistance Request

PCMH Assistance is available in two ways:
- 1. Trainer assistance option
- 2. Generating reports
Please check off which option(s) you are requesting below:
Assistance from a Trainer:
*Note additional work done by a trainer outside of a scheduled session is billed at $120 per hour.*
- On-site assistance (Sessions are billed at $500/per session, up to 3 hours)
- Remote/web assistance (Sessions are billed at $250/per session, up to 2 hours)
Assistance with Generating Reports:
*If you require assistance with reporting outside of standard reports, this will be billable at $150 per hour. *
- I am requesting assistance generating required reports
Please provide a description for what areas and/or reports you would like help with:*
Practice Name*
Account Number (can be found on Invoice):*
Contact Name*
First Last
Contact Phone*
Contact Email*
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