Submit a request – King's College Hospital

For LEAP service or support requests, please select the form labelled 'LEAP service/support form. For EPIC related enquiries then please select the appropriate EPIC support form from the list of four available.

Your email address

LEAP access reasons

Select the reasons you will be using LEAP for

Title

First Name

Last Name

Organisation(optional)

Your employer

Organisation (freetext)(optional)

Organisation (freetext)

Email address

Your work email address

System Login(optional)

This is what you use to login to Trust computers (ex. JSmith)

Position Title

Job Role

Department

Please select the department you belong to. If you are not paid by Kings then please select None Substantive Staff

Start Date

Termination Date (if known)

GMC No. (if applicable)(optional)

GMC No. (if applicable)

Contract Type

Staff Group

Manager's Name

Manager email

ESR number (on your payslip - if you have one)(optional)

ESR number (on your payslip - if you have one)

Description of issue

Please enter the details of your request. A member of our support staff will respond as soon as possible.

Attachments(optional)

Add file or drop files here