GA VHP RD Appointment Request

Request for VHP RD Call (CalAIM & Aetna Programs)
Member Name*

First NameLast Name
DOB*
Client ID *
Member ID *
Language
Phone Number*
InitialFollow-UpFinal
Kern Health System (KHS)Partnership HealthPlan of California (PHPCA)Inland Empire Health Plan (IEHP)Health Plan of San Joaquin (HPSJ)HealthNetContra Costa Health PlanCalVivaAetna Better Health of OhioAetna Better Health Kentucky
Please select a date and a start time for the member to receive a phone call from an RD. All times listed are Pacific.
Preferred date and timeslot for call:*
Preferred date and timeslot for call:*
Z Code
Additional Notes (Optional)
Name of Person Submitting this Form*
Should be Empty:

Request for VHP RD Call (CalAIM & Aetna Programs)