smeMetrics Cancellation Form

We are sad to hear that you would like to cancel your smeMetrics subscription with us. As much as we would like your continued patronage, we respect your decision to cease your agreement.

In this regard, we would like to know how we could be of better service to you in the future. Please could you fill out the below form so that we can improve our services.

Our cancellation policy is a one month cancellation period, please note once our system processes the cancellation we will cancel your access to the software. It is your responsibility to retrieve your saved data from the software before the end of your cancellation period. Once the cancellation has been processed all information will be deleted from our systems.

Name *

First

Last

Email *

Telephone Number *

Practitioner Type *

Dissatisfaction with: *

Service/product
Customer Service
Quality
None of the above

Reason for Cancellation *

Financial Reasons
Medical Reasons
Relocation
Other

If you clicked other please give us your reasons below *

Are you moving to a different billing software

Yes
No

If you answered yes above please let us know which software you are moving to. *

This information will be used to assist us with improving our services in the future

Date that services should be terminated *