Referral Information and Forms

Several specialty clinics in the Unified Clinics at Western Michigan University 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.

Audiology Clinic

No referral required. Call (269) 387-8047 to schedule an appointment.

Medical records release form

Behavioral Health Services

No referral required. Call (269) 387-8230 to schedule and appointment.

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

Client questionnaire for initial assessment

If you are a patient of Behavioral Health Services and would like authorize the use and disclosure of your confidential medical information, please complete this form and email it to Laura Hoskins or fax it to (269) 387-7026.

Children’s Trauma Assessment Center

Please find the instructions here for referrals to the Southwest Michigan Children's Trauma Assessment Center.

Language, Speech and Hearing 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 WMU Unified Clinics, 1000 Oakland Drive Kalamazoo MI 49008-5361. Call (269) 387-8047 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:

The Preschool Language Intervention Program:

The Preschool Language Intervention Program (PLIP) takes referrals from community providers, school systems, and self referrals from parents. Please call (269) 387-7145 for a phone intake and more information about PLIP.

Occupational Therapy Clinic

Finicky Feeders, Pediatric, Skills for Living, Work to Work:

The Occupational Therapy (OT) Clinic does not require a physician referral. However, you must complete a phone intake to be seen by a 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.

Vision Clinic

General and Low Vision Optometric Services:

No referral required. Call (269) 387-7064 to schedule an appointment.

Medical records release form

Western Evaluation Center for Autism and Neurodevelopmental Disorders (WECAN)

Physician referral is required for a diagnostic evaluation. Please complete our referral form, and fax the completed form with a physician prescription for Occupational Therapy evaluation and accompanying medical records to (269) 387-7026, ATTN: WECAN.

A brief screening process, including medical record review, telephone interview with caregiver, and history gathering will be conducted to ensure that our clinic is able to meet the referral concern. If so, a comprehensive evaluation will be scheduled with our clinic. If it is determined that our clinic is not able to meet the referral concern, we will refer to other community resources and agencies that will be able to address the family’s current needs. The referring physician's office will be informed of the outcome of this screening process. After completion of the WECAN evaluation and feedback with the family, the referring physician's office will be sent a copy of the diagnostic report and treatment recommendations.

Medical records release form

Women’s Health Clinic

No referral required. Call (269) 387-7000 to schedule and appointment.

Medical records release form