Submit a request

These forms are ONLY for inquiries from Healthcare Facilities. If you are a Healthcare Professional, you can contact our Support team directly through the “Start a Chat” option in your Clipboard Health app. If you have trouble logging in, please select “Technical Issues” from the dropdown below.

Please choose your issue below

Your email address

Subject

Urgent Shift(optional)

Are you a Healthcare Professional or a Healthcare Facility?

What was the facility type for the shift in question?(optional)

Please select the most appropriate Shifts related contact reason

Please select the appropriate Shift Booking type if applicable(optional)

Please select the appropriate Shift Confirmation type if applicable(optional)

Please select the appropriate Shift Cancellation type if applicable(optional)

Details of Shift Related Request:

Please select the most relevant Timesheet query:(optional)

Do you experience a pop-up noting missing document requirements when you try to book?(optional)

Other Reason for Contact(optional)

Name of the Facility in question?(optional)

Shift Date(optional)

Please enter the date of the shift in question

Shift Block(optional)

What is the time block for the shift in question?

Description

Please enter the details of your request. A member of our support staff will respond as soon as possible.

Attachments(optional)

Add file or drop files here