Connectors Support Request Form

Requester Details:

Client Information:

NOTE: Consumer facing issues need to first be sent to Support. Only provide this information IF you have an escalated case that has already gone to Support,has been more than 3 business days, AND you would like reviewed due to the complexity of the case.


Notice of Privacy Practices

Your Health Idaho is committed to maintaining the privacy and security of personally identifiable information. Your Health Idaho will use personally identifiable information only as permitted by Your Health Idaho's policies and as required by law.

More information about Your Health Idaho's privacy and security practices and your rights is available on Your Health
Idaho's website at YHI Privacy Policy

If you need help understanding this form in another language, or if you are disabled and need help to use this form, please contact Your Health Idaho. There is no cost for assistance.


Read and Sign Below - Electronic Consent