Provider Profile Questionnaire
Legacy Health Provider Profile Questionnaire
As Legacy's link to the community, it is important that Legacy Referral Services has current and accurate provider information. Click the link below to access the form. Your Legacy P Number will be required. If you have questions, please contact us by email at firstname.lastname@example.org or by telephone at 503-335-3500 (Oregon) or 360-487-3500 (Washington).
CLICK HERE TO ACCESS THE PROVIDER PROFILE QUESTIONNAIRE