• Please complete the following form when requesting termination of services for a client server.
  • Please take into consideration the amount of time needed to submit claims and work outstanding receivables.
    Date Format: MM slash DD slash YYYY
  • Once deactivated you will no longer receive lab information or be able to electronically prescribe medications. In addition, your patients will no longer have access to the STI Patient Portal.
    Date Format: MM slash DD slash YYYY
  • STI requires a 90-day notice when canceling your Managed Services contract.
  • Please choose one of the following four options.
  • Date Format: MM slash DD slash YYYY