Vital Care of Auburn Hills Referral Forms

for Providers

Immunoglobulin Therapy Referral Form

Specialty Neurology Referral Form

Select the appropriate treatment form from the referral forms listed above to download the form.

Please fill out and submit your referral forms via fax to (888) 720-5460 or email intake@greatlakesvc.com.

If you do not see the correct form, please call (888) 720-5450 or email contact@greatlakesvc.com.

In addition, Vital Care of Auburn Hills might request additional documentation for insurance purposes and information that is relevant to patient therapy which required documentation can be found listed on the referral forms under the Essential Data checklist

Alpha-1 Therapy Referral Form

Specialty Gastroenterology Referral Form

Rheumatology Therapy Referral Form

Dermatology Therapy Referral Form

Per Michigan Legislature, MCL-33.17754a, on January 1, 2023, all prescribers are required to electronically transmit all controlled and non-controlled substance prescriptions unless otherwise exempt under the statute (technological or electronic failure, waiver, delay in care, etc.).

Vital Care of Auburn Hills is a licensed pharmacy authorized to receive prescriptions electronically.

Additional alternative Vital Care of Auburn Hills Referral Forms can be found at Vital Care of Auburn Hills - VitalCare.

Vital Care of Auburn Hills Referral Forms

for Providers

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