Treatment Request - Dialysis Finder

Request Dialysis Treatment

If you are a DaVita patient or desire treatment at a DaVita center, and you need dialysis treatment within the next 7 days, call DaVita at 1-866-889-6019 and a dialysis placement specialist will assist you.

Otherwise, if you have more than 7 days to plan and you are already a DaVita patient, you may use this form to request DaVita assistance in placing you at any center of your choice. Please have your destination address and ZIP code available before you begin.

Please note: Do not use this form if you are not a current DaVita patient and you wish to be placed in a non-DaVita center. Information submitted by a DaVita patient, or individuals who wish to become DaVita patients, will be governed by DaVita's Notice of Privacy Practices

Important note for DaVita peritoneal dialysis patients: If you wish to travel and would like a back-up center call 1-866-889-6019.

You are requesting treatment at:

SOUTH LAS VEGAS DIALYSIS CENTER
2250 S Rancho Dr, Ste 115, Las Vegas, NV 89102-4456

Phone: 866-889-6019
Fax: 7027951794
Reference #: 540

* Denotes a required field

Patient Information

* Patient First Name

Middle Initial

* Patient Last Name

* Patient Date of Birth

* Patient Phone

* Patient ZIP Code

Treatment Information

* Home Facility Name

* Home Facility Phone Number

* Home Facility Country

* Home Facility State

* Dialysis Access Type

* Treatment Schedule

* Treatment Schedule Flexibility

* Primary Insurance

Dialysis Placement Information

Destination Street

* Desired City or Town

* State Where Center is Located

* Arrival Date

* First Requested Treatment Date

* Last Requested Treatment Date

* Departure Date

* Distance Willing to Travel to Center:

Additional Information: