MED-X Notice Form

Use the MED-X Notice Form to send a message to MDH indicating that you would like a Minnesota Department of Health's MED-X Program Investigator to contact you.

Your name: * required
Your e-mail address:  
Verify e-mail address:

Your phone number:

Notice: Please do not include any private or sensitive information in your message (such as identifying patient information, social security numbers, orcredit card numbers). If you need to give us private information, please contact us by phone at 651-201-5414 or 1-800-676-5414.

Your questions or comments:

Limited to 1800 characters
remaining.

After you submit your form, someone from the Minnesota Department of Health's MED-X Program will contact you for more information if needed. This form is only intended as an intial point of contact.

For more options for reporting, or additional information, see MED-X Case Reporting.