Physician Referrals

Welcome Healthcare Providers!

If you are a healthcare provider looking to submit a referral online to any Renue location, please use the HIPAA-compliant form below.

Our Physician Referral form is designed exclusively for healthcare professionals seeking to refer their patients to our expert physical and occupational therapy services. If you are a patient or a friend seeking our services, we kindly ask you to reach out to us through our refer-a-friend program. We appreciate your understanding and look forward to collaborating with healthcare providers for optimal patient care.*

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URL

This field is for validation purposes and should be left unchanged.

Date of Referral

MM slash DD slash YYYY

Patient Name(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Patient Phone:(Required)

Choose a Treatment Location(Required)

Choose a Treatment Location*Au Gres - 401 E. Huron Rd.Auburn - 4760 Garfield RdBay City - 2618 Center Ave.Bay City West - 3720 Wilder Rd., Ste DBridgeport - 5460 W. Rolling Hills Dr.Caro Hooper - 465 N. Hooper St.Caro M81 - 1796 W. Caro Rd., Ste IIFrankenmuth - 406 W. Genesee St.Freeland - 7329 Industrial Dr.Midland - 2524 W. Wackerly St.Oscoda - 4431 N US-23Saginaw - 3901 Bay Rd.Saginaw - 4616 State St.Saginaw - Saginaw YMCAShields - 8680 Gratiot Rd.Tawas - 540 W. Lake St.

Evaluate and Treat *(Required)

Evaluate and Treat - Physical Therapy

Evaluate and Treat - Occupational Therapy (OT available only at Bridgeport, Caro - Hooper St., Frankenmuth and Saginaw - Bay Rd. clinics)

Diagnosis(Required)

(Diagnosis to be evaluated and treated)

Please list any specific orders

Provider Name(Required)

File Upload

Max. file size: 2 GB.

Please upload any additional files here; health history, insurance information, etc.

Provider Signature *(Required)