Let’s get started.

Please complete the following steps to begin your treatment journey:

  1. Download the Referral Form (PDF). Click here.

  2. Have your physician, or whoever is treating you, complete the form. They’ll send the form to us.

  3. We’ll give you a call.

If you have any questions about treatment options, directions, or if you’re having difficulty downloading the Referral Form, please give us a call at 269.250.8688.

 
Name *
Name
Preferred Method of Contact *
(i.e. Wednesday afternoons and after 5pm on Fridays)

Disclaimer: This form should not be used to communicate any confidential personal or medical information (PHI), but should only be used for general questions.