New Provider Contract Inquiry Form and Instructions
Interested in becoming a Provider in our Network?
Below are links to the instructions/requirements you will need to follow, as well as the New Provider Contract inquiry form that needs to be filled out and submitted..
Click on the first link to access, review, and complete the checklist. This form can also be downloaded.
Click on the second link to open, complete, and submit the form.
DWIHN Provider Contract Initiation Requirements (Please Read Before Completing Form)