This application is the first step in the request process for an agreement that will allow for access to Epic software, documentation, or other related information for the purpose of supporting an Epic customer. Before being granted any Epic access for the project you are submitting an application for, you need a completed agreement in place. Please do not confuse submitting this application with having an actual agreement.

You can submit one application for access even if you have multiple consultants working on the customer project needing Epic access (no need to fill out an application for access for each consultant working on the project).

For additional questions, please email Epic User Support or contact the Consultant Relations team at 608-271-9000.

All fields are required except where otherwise noted.

Firm Contact Information

(Include Inc., LLC, Corp., etc.; if you are an independent contractor, please list your full legal name.)
(If you are an independent contractor, please list your primary mailing address. Please spell out state.)

Please provide the contact information for an authorized executive at your company to serve as the corporate contact. Should Epic approve your request for access, this individual will receive the drafted agreement for signature. If they are not the appropriate signatory, they may forward to the appropriate person at that organization.

Applicant Contact Information

Please provide your name and contact information. We will contact you with any questions about the submitted application.

Overview

Epic Customer Information

Project Information

Subcontracting Information

Consultant Firms and their Subcontractors must submit separate access requests. Independent contractors working through a different firm are considered Subcontractors.

NOTE: The Consultant Firm is the company that has the contract directly with the Epic customer.

Subcontractor Company Services Being Subcontracted
Contractor Company Services Being Subcontracted

Access Requested

If your organization will provide multiple roles at the customer, you can request multiple access groups on this application.

Specify at least one access group.

Notes

Please provide any additional notes or details pertinent to the Epic access requested.