Dialysis insurance consultation request

Fill out the form below or call a DaVita Guest Services Specialist at 1-800-400-8331 to set up an appointment to talk with a DaVita Insurance Specialist. We’re here to answer questions about your dialysis coverage at absolutely no charge. You’ll be receiving a phone call in two to three business days after we receive your information.

You may also want to read our Maintaining employment and insurance on dialysis book for more information. Log in your web account or sign up at to get your copy.

All fields are required unless marked "optional."

Your information
Are you the patient?	Yes No
Is the patient a Davita patient?:	Yes No

Your first name:
Middle initial:		(optional)
Last name:

Date of birth:		MM/DD/YYYY

Zip Code:
Phone number:		(999)999-9999
E-mail:

Patient information (if different from above)
Patient first name:
Middle initial:
Last name:

Date of birth:		MM/DD/YYYY

ZIP code:

Additional information
Primary insurance:
Primary insurance name:		(optional)
I have health insurance
Best time to call:		(optional)

What type of information are you looking for?		(optional)

This site is for informational purposes only and is not intended to be a substitute for medical advice from a physician. Please check with a physician if you need a diagnosis and/or for treatments as well as information regarding your specific condition. If you are experiencing urgent medical conditions, call 9-1-1

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Dialysis insurance consultation request

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Dialysis insurance consultation request

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Health information

Tools

DaVita services

DaVita products

Nonprofit

About DaVita