Physicians Forms
Support
Referral Form (Print to Fax)
Initial Order Form (Print to Fax)
In-Center Hemodialysis
Home Dialysis
Peritoneal Dialysis
2728 Questionnaire (Print to Fax)
Requested NKC Facility:
Please select Option 1, Option 2 or Option 3:
Option 1:
Upload Face Sheet and Submit Referral Electronically
Option 2:
Submit Referral Electronically and fax the Face Sheet to 206-343-4124
Option 3:
Print Patient Referral Form and Print Patient Face Sheet then fax both to 206-343-4124