Referral Information and Forms

Unified Clinics

Several specialty clinics in the Unified Clinics at ��ϲʹ��ֱ�� require referrals before you can be seen by clinicians. Look below for forms and procedures to help you get an appointment at the clinic you would like to attend. Privacy Policy

Audiology Clinic

Please have your primary care physician send a referral to (269) 387-7026.

Resiliency Center for Assessment and Treatment (RCAT)

The Resiliency Center for Assessment and Treatment offers Occupational Therapy and Social Work Services for children, youth, adolescents and their families.

Occupational Therapy - A physician referral is required for the following services;

Occupational therapy for youth and adolescence
Caregiver co-regulation coaching
Trust-based Relational intervention (TBRI)
Social Skills Group
Food selectivity intervention

Counseling services - A physician referral is not required for the following services;

Outpatient therapy and trauma treatment for families, youth, and children
Outpatient therapy services for adults
Autism diagnostic through ADOS evaluation
Trauma assessment
Fetal Alcohol Spectrum Disorder (FASD) Evaluation (Resiliency Center FASD Diagnostic Center). Evaluation (Resiliency Center FASD Diagnostic Center).

Medical records release form

Behavioral Health Services

No referral required except if your insurance is *Medicaid. Call (269) 387-8230 to schedule and appointment.

*All clients insured by Medicaid will need to contact Southwest Michigan Behavioral Health at (800) 781-0353 to be referred to our clinic.

The following forms may be filled out before your appointment to save time at check-in.

Client questionnaire for initial assessment

Language, Speech and Voice Student-led Clinic

Speech-Language Evaluation and Treatment:

The speech-language clinic takes referrals from any source, including personal referrals from friends or family members. Individuals or agencies may contact the clinic to request an application for services (evaluation or treatment). Once the application is received, the clinic will contact the applicant to set an evaluation appointment, or the clinic will add the applicant to a wait list for services for the upcoming semester.

Please fill out the appropriate form(s) and either email, fax to (269) 387-7026, or mail to ��ϲʹ��ֱ�� Unified Clinics, 1000 Oakland Drive Kalamazoo MI 49008-5361. Call (269) 387-7059 for more information.

For Aphasia Communication Enhancement (ACE), Preschool Language Intervention Program (PLIP) or general clinic services:

For voice, respiration and/or resonance services:

For release of medical records:

Occupational Therapy Student-led Enrichment Clinic

Pediatric, Skills for Living, Work to Work:

The Occupational Therapy Student-led Enrichment Clinic does not require a physician referral. However, you must complete a phone intake to be seen by a student clinician. The clinic supervisor reviews the phone intake information and informs clients whether they can be seen at one of the clinics. If the clinics are full, the client can be placed on a waiting list.

Please call (269) 387-7074 for additional information and to complete a phone intake.

Medical records release form

Psychology Clinic

No referral required. A 30 to 45 minute intake session is scheduled with prospective clients. This appointment serves to inform the client of the procedures of the clinic and also to obtain more information regarding the client's specific concern. Please call
(269) 387-8302 to schedule an intake session.

Because of the training nature of the clinic, the wait list is not handled on a first-come, first-served basis. We cannot guarantee when your case will be assigned to a therapist. However, we will regularly inform you of your status on the waiting list. We make every effort to serve as many clients as we can.