REPORT AN ISSUE HELP US KEEP THE PROVIDER SEARCH ACCURATE & UP-TO-DATE REPORT AN ISSUE HELP US KEEP THE PROVIDER SEARCH ACCURATE & UP-TO-DATE You must have JavaScript enabled to use this form. Did you find inaccurate or out-of-date information? Did you find inaccurate or out-of-date information? If you find an discrepancy —such as a listed provider who is no longer at that location, not accepting new patients, or out-of-network— please let us know. Please provide as much information as possible. CONTACT INFORMATION Submission Date * Submitter First Name Submitter Last Name Email Phone * By providing your email address and/or phone number, you authorize us to contact you through email, phone, or text regarding your colorectal cancer screening FIT kit, including order confirmations, reminders, and results‑related information. You may opt out of these communications at any time. PROVIDER INFORMATION Type of Provider Medical Provider Behavioral Health Provider Hospital Urgent Care Clinics Telemedicine Services Other Providers Provider, Organization, or Location Name * SELECT A ISSUE CATEGORY category_types * - Select -Address is incorrectPhone number is incorrectThis provider’s specialty is not accurateThis provider does not take my insuranceThis provider is not taking new patientsSomething else is wrong PROVIDE DETAILS ON THE INACCURATE INFORMATION Please be as specific as possible. Examples of discrepancies or issues: The provider is no longer at this location / has left the practice. The provider is not accepting new patients, contrary to the directory listing. The provider does not accept this insurance plan.The phone number or address listed is incorrect. Details (Please be as specific as possible) * Leave this field blank
