Is there a form for providers who won't accept Impact?

What if my provider won't accept Impact?

Provider Outreach Request

If your provider is unsure or unwilling to accept Impact, please fill out the form below and we will reach out to them.

Provider Outreach Request Form

To ensure that our team can contact your provider, please make sure you have a scheduled appointment that is at least 72 hours after the submission of this form. If your need is urgent, please contact 855-378-6777.

Not applicable to participants of the Senior Program