Submit a Referral

Send a Referral in Minutes

Use the secure form below to upload your referral documents directly. We’ll confirm receipt with both your office and the patient and begin the process right away.

Referral Checklist:

Diagnosis and ICD-10 Code

Relevant labs

Insurance information

Patient demographics

Prescribed medication and dosing

Download Referral Forms

What We Handle After You Send a Referral:

We contact your office and the patient to confirm receipt.

Begin prior authorization and explore coverage options.

Coordinate scheduling and nursing.

Provide updates throughout the entire process.

Upload Your Referral
Or Fax To: 616-280-4214

Download Referral Form
Upload Referral