You can complete these forms for:

  • Yourself

  • A Family Member

  • A Friend

  • A Client

  • A Patient


We are committed to partnering with community-based health educators, midwives, doulas, peer counselors, and health boards to ease access to our services and programs.

Please complete the referral forms below and we will enroll them into care for the services requested. 

All information you share goes directly into a HIPAA protected secure environment.

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Phone: 206-712-7352  |  Fax: 1-888-435-9983  |  |  4200 S. Othello St. #122 Seattle, WA 98118

©2017 Rainier Valley Community Clinic. All Rights Reserved. Rainier Valley Community Clinic is a registered 501(c)(3) organization, EIN 47-3348689.