Dieses Formular benötigt JAVA-Script!
A precise fault report is half way to removal
Fill in the following fault report in detail to ensure the quickest possible removal of failure:
Please complete a separate report for each failure!
Service hours:

Mo to Fr from 8 a.m. to 6 p.m. CET with the exception of public holidays in Hesse.
Please send the fault report to support@vepro.com or fax it to +49 (0) 6157-800686.

Emergency service for customers with a 24/7 service contract outside our business hours:
Please send the fault report to support@vepro.com UND call our hotline +49 (0) 6157-800688.
1. General information
a.) Customer address
Institute Name:*
 *
City:*
 *
b.) Person writing report
Name:*
 *
Phone:*
 *
E-Mail:*
 *
Position:*
 *
Available from / to:*
 *
 *
Time of day
Time of day
Mobile phone number
If you would like to receive a text message when the case is
closed, please give us your mobile phone number.
Who else should be informed about the progress of the failure removal?
Name:
Phone
E-Mail:
Available from / to
Time of day
Time of day
c.) Did you discover the failure?*
If you did not discover failure, who did?
Name:
Phone
E-Mail:
Position:
Available from / to
Time of day
Time of day
d.) Has the system administrator been informed of the failure?*
e.) Which type of service agreement/contract is in place?*
 *
2. Priority
a.) Is patient security still guaranteed after a system failure?*
If no, please enter the reason for this here:
b.) Can Patient data still be acquired and saved into the central database?*
c.) Is it possible to call up patient data on other stations out of the central VIS/PACS database?*
d.) What priority level would you assign to the failure removal?*
 *
e.) We hereby approve the remote trouble shooting:*
 *