Make a Referral

Refer a family to Kids’ Health Connections

If you would like to refer a family to KHC for services, you may download our
referral form by clicking the “DOWNLOAD FORM” button below, and fax the form
to (313) 659-3298.  Or, you may submit your referral online using our
NEW secure “Online Referral Form”!

If you are a physician who is interested in learning more about becoming a family-centered
medical home or to join KHC, please contact us at (313) 863-CHAP (2427) or click here to
send us an email.