Top Left
Top Right

Need IT Help? Have a Request for IT Service?

You Are in the Right Place!

Just fill in the information on the right to let us know how we can help you. If you do not have the information for a required (*) field, please type in N/A. If you have questions about how to complete this form, please call the Service Desk at
(714)937-7460

Note: Although IT requests submitted through this form receive priority over email requests, some IT requests may take from 3-5 Business days to complete.








*** If you have a Security Access Request, you will need to a fill out the Security Access Form via Carenet

First Name: *
Last Name: *
Contact Phone Number: *
Alternate Contact:
Alternate Contact Number:
Site Name: *
Department:
Is this patient care impacting?:
Please briefly explain how this is affecting patient care:
Incident/Request Type:
Description of Problem or Request:
Do you have a workaround for this issue right now?
Error message (If any):
Impact:
How quickly does this need to be resolved?
Attach File: