Request a Pick-Up

Doctor's Name

First Name

Last Name

Practice Name

Location

What city/town is the practice in?

What time do you close today?

To ensure we can get an EPIC representative to you in time, please tell us when you will close today.

What are your business hours tomorrow?

In case we are not able to get to you today due to the timing of the request or the delivery route, please let us know if you're open tomorrow (or the next business day), and if so, what are your hours? We want to get your pick-up as soon as possible.

Special Instructions

Please share any important or specific instructions.