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Doctor Checking a Form


Prospective patients and previously established patients that have not been seen in over three years, please be aware that our providers require a referral. Referrals must be processed and accepted before you can schedule an appointment. Please note, signing a release of medical records with your current provider and having records faxed over will not be accepted; we must receive an actual referral. Referrals must be faxed with the required supporting records; we cannot accept walk-ins with printed referral forms as they do not include required records.


Please have your primary care physician or current Ob-Gyn complete the referral form below and fax a referral to (616) 301-9899 (referrals must be faxed, they cannot be interfaced via Epic or sent via email). The referral must include patient demographics, insurance, supporting records (including anything relevant to why you would need to be seen such as recent visit notes, pap history, any relevant lab work results or imaging reports), and a clinical reason for the referral. Note: a referral must come from a physician; prospective patients cannot self-refer using this form even if insurance allows for self-referral.

Advanced Ob-Gyn Referral Form


Once the complete referral is received, it will be processed by our referral coordinator. If the referral contains all necessary records and demographics, processing will take two to four weeks. All referrals are reviewed by our physicians and timing is subject to their availability. You will receive a phone call to schedule an appointment once the referral has been reviewed and you have been accepted. If the referral is missing any demographics, records, etc this may result in a delay in processing, as we will need to contact the referring provider for more information.


To check the status of a referral, please contact the referring provider's office. Some offices can take weeks to prepare and send a referral. Verify that they have used the referral form above and included all required demographics and records, and have sent the referral via fax.

Please see our Prospective Patients page for more information. If you have any other questions about becoming a patient, please call (616) 971-0060.

Our practice no longer provides obstetric or midwifery care. We cannot accept referrals for prenatal care and delivery, OB consultations, or other midwifery services.

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