Submit a request

Please select the most appropriate form from the list below.

Your email address

Subject: Please describe the issue you are reporting

Description: Please include details/pertinent information related to the item you are reporting.

A member of the Sandata support staff will respond to your request as soon as possible. If submitting after business hours, response will be on the next business day. If you have an urgent request, please contact the Customer support team at your agency's designated phone number.

Your Name

Phone Number : Please provide the best number to reach you in case we have additional questions regarding your request.

State

Name of Organization

Medicaid ID

If you do not know your organization's Medicaid ID number, please enter "Unknown" in the Medicaid ID number.

Caregiver STX ID

Your STX, or company ID number (enter 'unknown' if you do not know this ID number)

Role at the Organization

Name of Administrator

Attachments(optional)

Add file or drop files here

Categories

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