Online Referral Form

Complete and submit the form below — and a practicing therapist/Advantage OT clinic director at the Advantage OT clinic of your choice will contact you to arrange treatment.

Referring Physician, Case Manager or Adjuster Information
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Clinton Township
40450 Hayes Rd
Clinton Twp., MI 48038
586.226.0434
Email: aellis@advantageot.com
Map
Fax: 586.226.2252

Westland
32500 Warren Rd
Westland, MI 48185
313.592.0038
Email: mpolydoras@advantageot.com
Map
Fax: 313.592.9055

Wixom
29650 South Wixom Rd
Wixom, MI 48393
248.682.5423
Email: cturner@advantageot.com
Map
Fax: 248.682.0444