If you would like to make a referral, please complete the online form below and be sure to upload the "Release of Information" form from referring Physician along with any ot her paperwork you may have.

Once the online form is complete, someone from our office will get back to you as soon as possible.

If you would prefer to speak to someone immediately, do not hesitate to call us at 586-273-7095.

Please enter your information below:

Click or drag files to this area to upload. You can upload up to 4 files.
The following file formats are allowed up to a max size of 10 MB each: .doc, docx, .txt, .pdf

Privacy Statement:

The Center for Counseling has a firm commitment to the confidentiality of user data. Any information gathered from this form is the sole property of The Center for Counseling and under no circumstances will your information be resold or given to any third party.