Secure Form

Rush Work Order

Company name:

Customer contact information:

First Name:

Last Name:

Email:

Phone:

Title:

Description of rush work request:

I acknowledge that I am requesting the scope of work described above to be completed by Mediprocity at the highest priority and without a formal Statement of Work "SOW".

I acknowledge that work created without a formal SOW is done with minimal testing by Mediprocity staff. Mediprocity will prioritize getting the work done quickly over testing it thoroughly. Mediprocity may perform only cursory tests on rush work, time permitting.

I acknowledge that the accuracy of the work depends heavily on the accuracy and depth of detail in the request for work that Mediprocity receives from me. Complete and accurate details of the rush work are essential for the work to be completed to my satisfaction quickly.

I accept the risk of unintended errors or complications that may arise from doing a project without the research and preparations that a typical SOW would allow for. Functionality of my installation of Mediprocity and associated forms, SureCount, dashboards, etc., that is unrelated to this request could become broken or malfunction during the rush work.

Signature:

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Date

I accept the legal terms and conditions