Request for Customer Service

At The Everett Clinic, we work to do what is right for each patient. With MyChart, at, you can submit a secure, confidential request.

Otherwise, call customer service at 425-258-3900 or use the form below to request a representative call you.

Please note this form is not secure, not meant for private medical and financial information.

Submit a Request for Customer Service

Physician/Employee (If Applicable)
Name (*Required For Follow-Up)
Patient Name (*Required For Follow-Up)
Phone (*Required For Follow-Up)
Best Time of Day to Call:

Address (*Required For Follow-Up)
I understand this form is to request a phone call from a customer service representative and financial and medical information should not be shared through this form. The form is NOT secure and is not designed for immediate communication. It is not intended for any patient care or financial issues such as billing or insurance questions, appointment requests, prescription refills, inquiries about medical test results or other confidential communications with my healthcare provider.
Customer Service at The Everett Clinic