For Referring Providers

At CHC, our goal is to make referrals easy and convenient for you and your patients. As part of the healthcare community, we are committed to:

• promoting positive referring provider relationships
• encouraging effective communication
• providing forums for education and learning
• providing information on what is happening at CHC

Making a referral

You may make a referral through Great Lakes Health Connect, the leading Health Information Exchange (HIE) in Michigan. Their website allows for HIPAA compliant electronic information exchange to facilitate appointments. It provides referring physicians with office tracking capabilities for referrals.

Alternatively, you may fax our referral form to one of our locations listed below.

Cancer & Hematology Centers East – Benign Hematology Clinic
Fax: (616) 389-1695

Holland Cancer Center
FAX (616) 389-1714

Cancer & Hematology Centers – Muskegon
FAX: (616) 977-4847

Lacks Cancer Center at Saint Mary’s
FAX: (616) 977-4846

Lemmen-Holton Cancer Pavilion
FAX: (616) 389-1708

Our representatives will promptly schedule a patient appointment, reach a consulting physician and provide help with any needed arrangements or information about CHC.

Referral Forms

The following New Patient Referral Forms are available.

• • Referring Provider Checklist (pdf)
  • Referral Form – CHC East, Benign Hematology (pdf)
  • Referral Form – Holland Cancer Center (pdf)
  • Referral Form – CHCWM Muskegon (pdf)
  • Referral Form – Lacks Cancer Center at Saint Mary’s (pdf)
  • Referral Form – Lemmen-Holton Cancer Pavilion (pdf) (pdf)