Davita w2 request 2026

1. Click ‘Get Form’ to open the davita w2 request in the editor.
2. Begin by filling out the Requestor Information section. Enter your name and title, followed by an email address where you would like to receive the online application. Ensure this is not a DaVita teammate's email.
3. Complete the Date Completed field to indicate when you are submitting the form.
4. Move on to Practitioner Demographics. Fill in all required fields such as First Name, Last Name, DOB, Social Security Number, and Gender. Make sure to select your Specialty from the dropdown list.
5. In Practice Information, provide details about your practice including name, address, city, state, and phone number.
6. For Facility Requests, specify any facilities you wish to add or remove from the practitioner’s profile by filling in the relevant fields for each facility.
7. Once all sections are completed, click 'Submit' to send your request directly to Credentialing Services.

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