New Facility Enrollment 

Please print and/or download the New Facility Enrollment forms by clicking the link below.  Once completed, please fax forms to (509) 418-5789 or email officeadmin1@pacwesthc.com

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You may also contact us by filling out "Contact Us" form below online and we will respond by either email or telephone

Please note patients must have patient enrollment form completed in full prior to being seen by PacWest Provider 

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*Please note we are servicing Spokane Wa and its surrounding areas at this time