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Join The SMASH Provider Network!
Please complete the form below and the SMASH Member & Provider Service Manager will be in touch.
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Name of Practice (if applicable)
Your answer
Email address
*
Your answer
Phone
*
Your answer
Website
Your answer
Area of Practice
*
Primary Care
Mental Health
Dental
Vision
Hearing
Physical Therapy, Massage, Body Work, or related field
Health Insurance Broker
Other:
How many members can you see annually?
*
It's okay if you don't know for sure how many member you can see annually. Please provide an estimate.
Your answer
Are you willing to provide discounted services?
*
SMASH providers offer a sliding scale for services because our member’s fall under the threshold to be considered low-income in King County.
Yes
No
Other:
Do you accept insurance?
*
Let us know if you accept insurance, specifically Apple Health because most members qualify. If you accept other insurance plans please list them below or email a list to MemberServices@SMASHSeattle.org
Apple Health
I do not take insurance
Other:
is there anything else you'd like us to know?
Your answer
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