Contact

 
Name:
 
Email:
 
Phone: 
State in which you practice (required):
How would you like to be contacted (required):
 
If you selected Phone, what's a good time to call?
Licensure: (required):
 
If you chose 'other', indicate type:
Approximately how many patients do you see a week? (required):
 
Reason for contacting us:
Type the current year in this box (four digits proving you're a human)

Contact

PH: 360-628-8612
FAX: 888-977-9060

Mailing Address:
PO Box 5585
Lacey, WA 98509-5585