Arkansas WebIZ Help Desk
Arkansas WebIZ Help Desk
Arkansas WebIZ Help Desk
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User Enrollment Request
Submit a Support Request
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Name:
Email:
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ARE YOU NEEDING A USER ENROLLMENT FORM?
YES
NO
**THIS TICKET IS FOR ENROLLMENT ONLY.
IF YOU ARE NEEDING CHANGES TO YOUR EXISTING ACCOUNT,THIS IS NOT THE RIGHT TICKET.
PLEASE SUBMIT A TICKET UNDER "I NEED HELP WITH MY USER ACCOUNT"
Have you ever had access to the Registry in any capacity?
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No
Job Title:
Do you administer vaccinations?
yes
no
Do you prescribe vaccinations?
yes
no
Facility name:
Facility Phone Number:
What is the best number to reach you at?
store# / clinic# (ex: Walmart #1):
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