Nuance - Dictaphone Healthcare Solutions - Support

You will be contacted regarding this request and receive a "Service Order Number" to identify your request in any subsequent interactions. The contact will also supply program details including specific instructions for packaging, shipping, total cost with tax included for repair, and filling out paperwork.

Fields with the * symbol are required.

Contact Information

Customer/Configuration Number:
Purchase Order Number:
*Contact Name:**
*Contact Telephone:**
*Best Time to Contact:**
*Company/Organization:**
*Street Address:**
*City:**
*State or Providence:** (Available to Canadian & U.S. Customers)
*Zip or Postal Code:**
*E-mail:**

Product Information

*Model Number:**
*Serial Number:**
*Is the Model/Serial number listed above under a maintenance agreement?:**	Yes No

Method of payment is required for all depot products not covered under maintenance:	Credit Card (We will call for the Credit Card Number and give you the total amount with tax.)
	Check in the Box

*Provide our Support Team as much detail as possible regarding the problem you are experiencing with the equipment::*