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The Peaks & Plains, Inc. forms and notifications you need to sign up:
For Facilities:
Facility Sign-up Form
Diabetic Log sheet for patient
Toileting Plan for Facilities. Use these to track resident's toileting, to show necessity for disposable glove usage:
Incontinence Care Plan for Glove Supplies, 2 day
Toileting Plan, 28 days
Peaks & Plains_Brief_Application_Guide
Individuals or Residents of a Facility:
Resident Sign Up Form, Private Pay
Resident Sign Up Form, Insurance
To update information for a resident with insurance coverage: Resident Update Form
To request a revision of the products on a resident's Dr's Order: Revision Request
Please read and print out for your records:
Complaint Resolution and Return Policy
Clients Bill of Rights
Privacy Practices Notification
Supplier Standards
If you need assistance, please call customer service at 1-800-585-4201.
Our office hours are Monday through Friday, Pacific time 8 to 5.
Please print out the sign-up form and fax (to 1-800-886-3122)
or mail the completed form.
Mail to:
Peaks & Plains, Inc.
6326 E. Trent Ave. Ste. A
Spokane Valley, WA 99212-1220
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