Refer a Patient
A simple process. A trusted partner. Choose whichever referral method works best for your practice — we handle everything from there.
Three Easy Ways to Refer
We accept referrals any way that fits your workflow. Once received, we contact the patient, verify insurance, and schedule within 24 hours.
Submit Online
Fill out our secure, HIPAA-compliant referral form below. No account needed — just enter the patient information and hit submit.
Download & Fax
Download our referral form PDF, fill it out, and fax it to (989) 256-0507. We process faxed referrals the same business day.
Call Us
Call (989) 320-4434 to refer a patient by phone. Our team can take the referral information over a brief call.
Online Referral Form
Secure, HIPAA-compliant, and submitted directly to our clinical team.
Prefer to Fax?
Download our referral form, complete it, and fax it to our office.
RevitalizeMe Referral Form
PDF format — print, complete, and fax.
Download Referral Form (PDF)Fax completed forms to: (989) 256-0507
What Happens After You Refer
Once we receive your referral, our team contacts the patient directly, verifies insurance and obtains prior authorizations, schedules the initial evaluation — often within 24 hours — and keeps you informed with progress updates at the frequency you choose.
Your patients stay your patients. We are simply an extension of your care.