A visit or schedule problem

Use this for missed visits, late arrivals, refusals and cancellations. It goes to the office right away.

What happened with the visit?

Choose everything that applies.

Write names the way you know them — we will match them to our records.

Client's name

Caregiver or staff member's name

When did it happen?

A sentence or two is fine.

So we can come back to you with questions.

Your name

Your role

Your email

Your phone number

Vitalis HealthCare Services