Portal Set-Up Request — Consortia Surgical Services (CSS)

Request for Customer Portal Set-Up

Please complete and submit the Customer Portal Set-Up Form Below and Click Submit when finished. You may also choose to download the PDF form which you may complete and e-mail to SUPPORT@ConsortiaSurgical.com

Printable pdf version

Facility Name

Contact Person

First Name

Last Name

Phone

(###)

###

####

Email Address

Notes/Comments

Best Time To Contact

Please indicate best time to set up Customer Portal Intro Conference Call