This form is only for King County providers. If you are requesting consultation and practice in a different county, please use this form: https://redcap.link/WTCNrequest

Please complete the fields below that pertain to your request. We will reach out to you within 2 hours , M-F 8:00AM - 4:00PM. If you submit your request after 4:00PM or over the weekend we will be in touch the following business day.

If you have an urgent after-hours need, please call 206-744-4579, option 2

This form is HIPAA compliant.

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