Vitalant | Healthcare Partner Connect

Healthcare Partner Connect

We’re here to help you. This Form is intended for customer reporting of compliments or concerns.

If your service event, question or need requires immediate assistance please contact your local service team directly.

Note: * indicates a required field

Are You Connecting From:

Customer

Vitalant Internal

* Your Name (first and last) or EIN Number:

Email:

* Phone Number (including area code):

* Reporting Facility Name:

Customer Account Number (10 Digit account number is located under Organization or User Profile): Note: Please include the leading 4 zeros on your account number

* Date of Occurrence:

Time of Occurrence:

* Please Select the Appropriate Category:

Compliment:

Was There a Patient Impact?:

Yes