We are here to support you on the path to Smarter, Better, Faster, Healthcare.
Request priority
For all other requests, please use the standard customer service form.
Anything less than 2 days requires rational for the urgency.
What is their purpose?
Please provide all necessary detail about the products/services to be included in the contract.
Yes / What Ratio or No
Please select if your request is related to training creation or a general question about training and development
What topic(s) or subject areas are you seeking? What problem are you trying to solve? (Please be as detailed as possible: "excel for beginnings", "Leadership training for new managers," etc.)
Who is your target audience? (managers, individual contributors, sales team, etc.)
How many learners (users) will need this training?
Is there a date by when you need to implement this training? As soon as possible?
Choose an option from the dropdown
Describe how you're conducting training
Are there any course features or formats you'd prefer? If you prefer more than one option here, please select "Other" and specify your preferences in detail.
Describe the other course features or formats you'd prefer
Are there any course durations you'd prefer? If you prefer more than one option here, please select "Other" and specify your preferences in detail.
Describe the course duration you'd prefer
Select the language requirements for the course. If you prefer more than one option here, please select "Other" and specify your preferences in detail.
Please describe any other language requirements you have for this course
If you have nothing else to add, please enter "n/a"
Please enter the details of your request. A member of our support staff will respond as soon as possible.
Owner: Business Owner (request) + Department Head (approval) **Action:** * Business Owner shares initial request information 1.) vendor name, 2.) business purpose/use case, 3.) timeline/urgency, 4.) estimated cost, 5.) impacted teams and completes the Standard Intake Form below. * Business Owner requests a copy of vendor's W-9 and NDA before submitting this request. * Business Owner seeks department heads approval for budget and cost center before submitting this request.
If you don't have a copy of the vendor's W-9, please request a W-9 from the vendor, then come back and submit this request. Please submit the vendor's W-9 at time of ticket submission.
If you don't have a copy of the vendor's NDA, please request a NDA from the vendor, then come back and submit this request. Please attach the vendor's NDA at time of ticket submission.
If you don't have written budget approval from the department head to proceed with this vendor, please request that along with the cost center and then come back and submit this request. Please attach the department head's written approval at time of ticket submission.
Where will the cost associated with this vendor be charged? Please ensure you have a valid cost center listed here before proceeding.
If there is an existing contract or agreement with the vendor, please include it as an attachment before submitting this request.
Since you answered Yes or Unknown to one or both of the above questions about PHI / PII access, please answer the following questions with as much detail as possible related to the data the vendor will be accessing. 1. What types of data will be accessed? 2. How is the data accessed? 3. Where is the data being access stored? 4. Is the data transferred outside the Valenz Health organization?
If you have a quote or proposal from the vendor, please include it as an attachment before submitting this request.
Please select a future date
Is there any additional information the IT Procurement, Compliance, IT Security, Legal, or Accounts Payable teams should be aware of related to this requests? Enter "N/A" if nothing to add.