Training Request Form

HealthCare Synergy

Training Request Form


To help us better serve you an meet your training needs, please fill out the requested information below. Upon completion and submission of the form your account manager will contact you for verification


If you are only interested in our free Online Monthly Webinar Trainings please visits (URL of webinars) to register for training.

Agency Name:
Contact Person:
City:
State:
Phone Number:
Email Address:

Online Training (One-On-One or Group)
*Agency would have to use prepaid training hours if purchased, or sign a pre-authorization form. Please inquire before scheduling and appointment

Onsite Training (Southern California and Michigan Clients Only)
*Only available in select areas

Proffered date and time of training

Date
Time
Please select which of the following you would like to be trained on

Synergy in the Cloud

Web Edition:

Additional Information