(Basic details to identify the user and app version.)
Full Name:
Email Address:
Organization/Hospital Name:
App Name & Version:
Device Type:
Operating System:
Date & Time of Issue:
Is this the first time you’ve experienced this issue?
(Detailed problem reporting to understand the nature of the issue.)
Type of Issue: (Select all that apply)
Login/Authentication Failure
Messaging Not Sending/Receiving
Notifications Not Working
Audio/Video Call Problems
EHR/EMR Integration Failure
Slow Performance/Lag
App Crashes/Freezes
Missing Patient Data
Other:
Detailed Description of the Problem:
What were you trying to do when the issue occurred?
What error message (if any) did you see? (Please provide exact wording.)
How often does this issue occur?
Consistently (It happens every time)
Intermittently (It happens sometimes, but not every time)
I'm not sure / Haven't tested enough
Have you tried any troubleshooting steps?
(Helps determine if the issue is network-related or due to device settings.)
Internet Connection Type:
Wi-Fi
Mobile Data
Hospital Network
Are other apps working normally on the same connection?
Have you checked app permissions?
Is the app blocked by your organization’s firewall/VPN?
Yes
No
Don’t Know
(For authentication, or access-related problems.)
Are you logging in via:
Email & Password
Single Sign-On (SSO)
Biometrics (Face ID/Touch ID)
Other:
Do you have multi-factor authentication (MFA) enabled?
Are other users in your organization experiencing the same issue?
Yes
No
Don’t Know
(For problems related to EHR sync, missing records, or API failures.)
Which EHR/EMR system are you using?
Epic
Cerner
Meditech
Other:
Is the app failing to sync patient records?
If data is missing, specify:
Patient Name/ID:
Missing Data Type (e.g., lab results, prescriptions, notes):
Have there been any recent updates to your EHR system?
Yes
No
Don’t Know
(Screenshots, logs, or screen recordings can help diagnose the issue faster.)
Description / File Name | Upload File | ||
|---|---|---|---|
1 | |||
2 | |||
3 | |||
4 | |||
5 |
Any other details that might help resolve the issue.
App Support Form Insights
Important Note:
This analysis provides strategic insights to help you get the most from your form's submission data for powerful follow-up actions and better outcomes.
AI-Generated Content: This template and its accompanying guidance are AI-generated to provide a practical starting point for your form-building needs. Please review and customise the content to ensure it is accurate, appropriate and suitable for your intended use.
This guide is provided for general informational and planning purposes only. It does not constitute professional, legal, financial, medical, employment, privacy, regulatory, or advice of any other kind, nor does it certify that this template is suitable or compliant for any particular jurisdiction or purpose.
Laws, regulations, industry practices and business requirements vary. You are responsible for reviewing and customising the template to suit your intended use and obtaining advice from appropriately qualified professionals where necessary.
Please delete this section before publishing your form. See our Terms of Service for further information.
Below is a detailed breakdown of the Clinical Communication App Support Form, explaining the purpose of each section, why specific questions are included, and how they help in troubleshooting and resolving issues efficiently.
Purpose:
Key Insights:
Why It Matters:
Purpose:
Key Insights:
Why It Matters:
Purpose:
Key Insights:
Why It Matters:
Purpose:
Key Insights:
Why It Matters:
Purpose:
Key Insights:
Why It Matters:
Purpose:
Key Insights:
Why It Matters:
Purpose:
Example Use Cases:
Mandatory Questions Recommendation
Important Note:
This section explains why certain fields in this form are marked as required and provides general guidance on how these requirements may support the collection of complete, accurate and relevant information.
Required fields and information-collection obligations may vary depending on your industry, jurisdiction, business operations and intended use of the form. A field marked as required in this template does not necessarily mean that collecting the information is legally mandatory.
Please review each required field to determine whether it is necessary, appropriate and lawful for your particular purpose. Consider applicable privacy, data protection, consent and industry-specific requirements, and consult an appropriately qualified legal, privacy or compliance professional where necessary.
Please delete this section before publishing your form. See our Terms of Service for further information.
These are essential for diagnosing and resolving issues efficiently.)
Why Mandatory?
Why Mandatory?
Why Mandatory?
Why Mandatory?
Why Mandatory?
Why Mandatory?
Why Mandatory?
Why Mandatory?
Why Mandatory (When Possible)?