Contact Us (Patients & Consumers) If you would like a representative to contact you, please complete and submit the form below. Patient First Name: * Required Patient Last Name: * Required Email: * Required * Required Invalid Email Address Phone: -- * Required Invalid phone number Best time to contact? * Required Requester Name (If different from patient): Relationship to Patient: State: CA AL AK AZ AR CA CO CT DE FL GA GU HI ID IL IN IT IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA DC WV WI WY Reason for Inquiry: I want information about HIE I want to Opt-In of HIE I want to Opt-Out of HIE Other - Please specify in the Comments field * Required Comments: 1000 characters remaining An HIE representative will respond to your question or comment as soon as possible (within 3 business days). If you need immediate assistance, please call us at (714) 937-7000. To contact us toll-free, please call (844) 256-4HIE (4443).