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History & Referral Forms

Client Information Forms & Health Care Provider Referral Forms required to apply to the Michigan Abilities Center are provided below in a Microsoft Word format, with the expection of the Prescription Form, which is a PDF file. The PDF file can be opened using Adobe Reader, which may be downloaded free by clicking the link below.

Client Information Forms

(please complete the forms listed below*)

Health Care Provider Referral Forms

(please have your physician complete the forms listed below*)

Please send the completed participant’s and physician referral forms by mail, email, or fax to:

Michigan Abilities Center
7286 W. Ellsworth Road
Ann Arbor, MI 48103
Phone: (734) MAC-9500
Fax: (734) MAC-9555
Email: MACinfo@MichiganAbilitiesCenter.org