·  Application For Access

This application begins the request process for access to Epic software, documentation, screenshots, or other related information for the purpose of supporting an Epic customer.

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

Role Epic Access Requested Access Level & Location
Create a new access group.
Specify at least one access group.

Notes

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