1887

Case submission form

You may wish to use to submit case details to VPIS. Contact/client/patient information is only requested to help identify the case should VPIS wish to ask for further details. All case details supplied are kept strictly confidential by VPIS. Severe or interesting cases, or those where VPIS is undertaking ongoing surveillance, referred directly to VPIS by telephone will usually be followed up by postal questionnaire as a matter of routine and so need not be submitted by this means.

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error