Health Connector Ombuds Office Contact Form

Complete the form below. Please do not include any additional personal information than what is required by the form, such as your full Social Security numbers, addresses, bank account numbers, or personal health information.

When you see a star , you must complete the field.

  • Reason for contact

  • Your information

  • MM/DD/YYYY format. For example, if your DOB is March 1, 1976, type in 03/01/1976.
    MM slash DD slash YYYY
  • This number is 12 digits and can be found on a bill or letter from the Health Connector.

  • Your message

  • You will add your full description in the "Your Message" box next.
    0 of 75 max characters
  • 0 of 1500 max characters
  • Please note that evening and weekend call back hours are not available at this time.
  • This field is hidden when viewing the form
  • This field is for validation purposes and should be left unchanged.