VitalConnect Patient Intake Form
Thank you for choosing VitalConnect!
Please be aware that there is no means to save this form. Insurance information, Vistatablet Name and Vitalpatch bluetooth ID's should be available when completing this form.
If you have questions, please email
or call 1-800-219-3000 and a Certified Cardiac Technician will be available to assist you from 7:00am to 4:00pm Pacific.
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This form was created inside of Vital Connect, Inc..