CenTrak

High Priority Request Form

The High Priority Request Form allows users to contact the Customer Success team by providing required personal and company information, selecting a subject from specified categories including Technical Support, and submitting a message, with an option to call the corporate office directly for immediate assistance.

You may call our Corporate office for a live response at 215.860.2928. Otherwise, please complete the priority request form below, which will be sent to our Customer Success team immediately.

Technical Support Requests: Please call 215.860.2928 or visit www.centrak.com/support for more options.

Priority Request Form Fields:

  • First Name (required)
  • Last Name (required)
  • Email (required)
  • Phone Number (required)
  • Company Name (required)
  • If part of a healthcare network, please also include the facility name
  • Subject (required)
    • Options: Accounting/Billing, PO Status, Sales, Technical Support, Other
  • Message

Submit