Our organization offers all modalities; providing patients with a variety of end-stage renal treatment options that best fit their lifestyles. As part of our mission, our Admissions Department will ensure that the admissions process is smooth and that all your questions are answered.We guarantee a response to all requests within 2 hours, between the hours of 8am-4:30pm CST, Monday through Friday.

Submitting An Admissions Request Form


To begin the admissions process download our Dialysis Care Center Admissions Checklist form.All completed forms must be submitted directly to our Admissions Department at For additional information or concerns contact a member of our Admissions Department at 844-466-3436.

Please note that the following information will be necessary to complete the Admissions Checklist:

  • Fact Sheet (with Demographics & Insurance Information)
  • Copy of Patient's Insurance Card (Front & Back)
  • Recent Dialysis Orders or Last 3 Treatment Sheets
  • Last 3 Dialysis Flow Sheets (In-Center Hemodialysis Only)
  • A 2728 Form (Transfer Patient)
  • HEP Panels
    • HEP B Surface Antibody
    • Hep B Total Core Antibody
  • All Current Labs (within 30 Days)
    • HEP C
    • CBC
    • BMP
    • Creatinine
    • Current Medications List (with Allergies)

Please do not discharge a patient until you have received confirmation of acceptance from a member of our team.