Request a proposal.

Tell us about your facility and your patients’ dialysis needs, and we’ll follow up to discuss scope, coverage and pricing. For a stat treatment request, please call.

Proposal request

Fields marked * are required. Please don’t include patient names or other protected health information.

Name *

Title (e.g. CNO, ICU manager)

Facility *

Email *

Phone

Facility type

Estimated monthly treatments

Message

Please don’t send patient health information through this form. For urgent or stat needs, call (214) 794-4199.