Referral

AmeriCare Medical, Inc. work in coordination with Case Managers, Insurance Adjusters, Discharge Planners, Physicans and other referral sources to ensure quality care for each patient.

If you would like to make a referral, please complete the following form and an AmeriCare representative will be in contact with you shortly. You can also contact us 24 hours a day, 7 days a week by phone at 248-288-2270.


Your Name*

Company name

Title

Your Email*

Your Phone*

Patient’s Name*

Patient’s Location*

How Did you Hear About Us?

Service Request

Additional Notes