Contact Us :: Washington State Department of Health 2026

1. Click ‘Get Form’ to open the Contact Us form in the editor.
2. Begin by entering your MTS Name and the Effective Date of Change. This information is crucial for identifying your request.
3. Fill in the MTS License # and CLIA #, ensuring accuracy as these are essential for processing your changes.
4. Indicate the Type of Change you are making, such as Address Change or Facility Name Change. Provide the current and new details as required.
5. For contact changes, enter the new phone number, fax number, and email addresses for relevant contacts. Make sure to double-check these entries for correctness.
6. If applicable, complete pages two and three only if you are changing the director of a categorized or accredited license. Fill in qualifications as per the instructions provided.
7. Finally, ensure that you sign and date the form at the bottom to certify that all information is accurate before submitting it.

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