VAC 24/7 Online Ordering

Request vascular access services

Complete the secure form below. VAC Dispatch receives your request immediately and sends the order number to your phone and email.

Sent directly to VAC DispatchText and email confirmationAvailable 24/7

Order information

Provide the facility contact and requested service details.

* Required fields

Ordering nurse or contact *

Return phone *

Facility name *Begin typing and select the facility when it appears. A new facility name may also be entered.

Service requested *

Room / bed *For several rooms, separate each room with a comma.

Is the client on dialysis? *

Yes

Unknown

Priority *

Routine

STAT

Contact email *VAC sends the order confirmation number to this email and the return phone above.

Special instructions (optional)