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

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.

Loading... Loading...
You have selected an option that triggers this survey to end right now.
To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.