Tell Us About Yourself
Please complete the following information then click the Submit Form button below. Please DO NOT include any HIPAA Electronic Protected Health Information (ePHI) e-mail communications in this request form. If you need to transmit ePHI, First Insight will direct you to a secure email site. If you do not receive an email from us confirming that we received your request, please call us at 800.920.1940. Thank you.
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Your Name (first, last)
Technical Support Categories:
Customer Support Payments
EyeClinic.net Patient Portal
For Customers Website Login
Upgrades and Licenses
Please rate the urgency of this request
Call me within next business day.
Call me to schedule an appointment.
Email me an answer.
Detailed Description of Support Request
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will not be received until the next business day.
If you do not receive an email from us confirming that we received your request,
please call us at 800.920.1940. Thank you.