Visitor Request Form

Please fill out all fields in this form to request visitor dialysis at Northwest Kidney Centers. If you do not hear back from us within 2 days of your email, please try again or call us at 206-720-8501.

Patient information

Dialysis dates



Your current dialysis provider

Additional information

CONFIDENTIALITY NOTICE: Northwest Kidney Centers' website is reasonably secure but is not encrypted. If you are not comfortable sending this information electronically, you may phone us at 206-720-8501. Our privacy notice