Please use the form below to request more information about programs and services provided by McLaren Homecare Group. Do not use this form in a medical emergency of any kind.
If you are requesting home health services for either yourself or a loved one, please note that submitting this form does not mean care will automatically begin. Specific criteria must be met for home health care services to begin and a physician authorization is required. The information you provide will be sent to our home health care team, who will respond to your request to address your questions/concerns and can assist you with coordinating the process.
* Indicates required information
Patient/Client Name: *
If you are a physician or are from a physician’s office, please provide the following information: