Request Dialysis Treatment at DaVita Park Plaza Dialysis

You are requesting treatment at:

DaVita Park Plaza Dialysis G1075 N Ballenger Hwy, Flint, Mi 48504-4431

Phone: 1-800-424-6589 Fax: (810) 235-9144

If you need dialysis treatments within the next 7 days, call 1-800-244-0680 and a Guest Services Contact Center Teammate will assist you. Otherwise, if you have more than 7 days to plan, complete this form in its entirety. Please have your destination address and or zip code available before you begin. This information is required in order to find the closest available facility to your destination.

Note: You only need to submit this form once per arrival date. If we can't find availability at this particular center on the date you requested, we will try to find the closest available center.

Important note for Peritoneal Dialysis patients: If you're wishing to travel and would like a back-up facility call 1-800-244-0680.

Thank you!

All fields are required unless marked "optional."

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Visitor Travel Information

* To request permanent placement at a DaVita center, please call 1-866-475-7757.
* For placement within the next 7 days, please call 1-800-400-8331. This form requires a minimum of 7 days notice.

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Your Information

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Patient Information

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Patient's Current Dialysis Center Information

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Treatment Information


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Additional Information