Add/Replace Billing Workstation Request Form

Please complete the following form to submit your request for a billing workstation setup. The fee for setting up a billing workstation is $250 per workstation. Your office will be contacted shortly to schedule a date for the setup.
Practice Name*
Name*
First Last
Phone*
Email*
Provide STI with the original workstation’s name and the new workstation’s name. You may need to check with your office’s hardware support vendor for assistance.
Original Workstation Name (1st Billing Workstation):
New Workstation Name (1st Billing Workstation):
Original Workstation Name (2nd Billing Workstation):
New Workstation Name (2nd Billing Workstation):
Original Workstation Name (3rd Billing Workstation):
New Workstation Name (3rd Billing Workstation):

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