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Referral

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Self/Family Referral

Information needed for referral:
  • Referral source name
  • Referral source phone
  • Reason client is being referred
  • Client first, middle initial, last name
  • Home address
  • Telephone number(s) (Client and Alternative)
  • Date of Birth
  • Medicare number
  • Primary and Secondary Insurance Info
  • Doctor info

Organization Referral

Information needed for referral:
  • Referral source name
  • Referral source organization
  • Referral source phone
  • Reason client is being referred
  • Client first, middle initial, last name
  • Home address
  • Telephone number(s) (Client and Alternative)
  • Date of Birth
  • Medicare number
  • Primary and Secondary Insurance Info
  • Doctor info, if available

How To Make A Referral

Phone Call

Call us at 616-309-0107 to provide information over the phone. Calls received after hours can leave a referral on our confidential voice mail. Please include caller’s name and phone number along with the necessary information for referral.

Email

Send us a confidential email to reclaimlifetherapy@gmail.com

Online Submission

Use our Contact Form to submit a confidential referral

Fax

Referrals can be sent to our twenty-four hour confidential fax system at 616-825-6185. Please use this referral form when faxing.

Questions?

There are two ways to contact us with questions:

For either method, someone will get back to you asap within the next 24-hours.