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  • Practice Hours
    734-362-5100
  • After Hours
    734-348-3710

Please use the Patient Portal for all communication to help better serve you.

Patient Portal URL
https://health.eclinicalworks.com/familyhealth

You can now request a referral using the patient portal. Before using this service, please be aware of the following:

  • This page is encrypted for your safety . Any information you provide is secure.
  • Filling out this form will notify our office that you are requesting a referral.
  • Notifications are checked several times daily until 4:00 pm
  • Do not submit more than one request, as this may cause confusion and further delay
  • Please allow 24 hours for your referral request to be processed
  • We will contact you if there are any problems with your referral request
  • If this is an emergency, please call our office at (734) 362-5100
  • Notifications are checked several times daily Monday –Friday until 4pm.  Please allow up to 72 hours for your refill request to be processed and filled .
  • PLEASE CHECK WITH YOUR PHARMACY FIRST TO SEE IF YOUR PRESCRIPTION IS READY
  • Sign In – Patient Portal

    • Ask questions
    • Request prescription refills and referrals
    • View your personal health
    • Examine your statements
    Sign In Now
  • Patient Information

    First Name

    Last Name

    Date of Birth

    Your Phone

    Your Email

    Comments

    Pharmacy Information

    Pharmacy Name

    Pharmacy Phone Number

    What Medications are your requesting?

    Medicaton Name

    Dosage (i.e. 30ml or 30 mg)

    Quantity