Support Case Submission
Form updated 8/9/21
This form is
configured to handle patient data. Please
submit Protected Health Information (PHI) through this form. If sharing PHI is required for your request, please note that in the description and further instructions will be provided to you for secure submittal of PHI.
First and Last Name
Please select this option if you want other folks in your organization to be copied on this inquiry
Add additional emails
First additional email
Second additional email
Third additional email
Fourth additional email
Fifth additional email
Urgency - Please select the statement below that best represents your request.
Configuration question. No significant loss of function
Minor loss of function resulting in inconvenient usage
Severe loss of function and no available workaround
Complete loss of function and no available workaround, resulting in critical business interruption (platform outage, downtime, etc.)
Identify the source of the issue or question.
If your inquiry spans multiple products, please submit a separate request for each product.
(Ex: Provider information needs updating on Google)
Reputation/Binary Health Analytics (BHA)/PG Consumer Analytics (PGCA)
(Ex: I'm not receiving alerts)
Transparency/Binary Star Ratings (BSR)/PG Transparency (PGTS)
(Ex: I’m not seeing new survey data)
(Ex: I’m not able to update information in Data Manager)
(Ex: I’d like to update a banner on our directory)
(Ex: The review links are not showing in the text messages to patients)