Karmanos Cancer Institute MAIN MENU SECTION MENU Call 1-877-KARMANOS Online Referral Form Download a Referral Form Karmanos Cancer InstituteRefer a Patient Downloads & Links Karmanos Patient Referral Form Refer a Patient Thank you for considering the Barbara Ann Karmanos Cancer Institute as part of your team. We want to make referring your patients as easy as possible for both you and your patient. Referral Options As a physician you can refer your patients to see our specialists for cancer treatment, or you can refer your patients to rule out a potential cancer diagnosis. Call 1-877-KARMANOS Download vCard Referrals to Karmanos can be made by: Phone: Call our referring physician line 1-877-KARMANOS (877-527-6266) to speak with a Karmanos representative Having the following information available when you speak to a Karmanos representative will make the process quicker and more convenient for you. Patient Information Patient’s full name Patient address (street, city, state, zip) Day, evening and emergency telephone numbers Complete insurance information Referring Physician Information Name Address Phone Primary care physician name, address and phone (if different) Information Needed for Appointment The patient should bring complete medical records including original films, slides and copies of reports of any mammograms, ultrasounds, biopsies, other relevant tests or medical history. We appreciate your help in securing these. Online: Fill out our quick and easy online form: Online Referral Form Fax: Download, complete and fax the form to 313-576-9827: Download a Referral Form Referral Materials What type of appointment are you requesting? Please download and fax to us the form pertinent to the type of appointment request, as well as the Authorization to Request Medical Records form. New Patient Referral Form – this form is needed for any patient who requires a consultation with our oncologists Radiology Appointment Request Form – form is needed for any patient who requires a mammogram, ultrasound or any other type of radiology service offered by Karmanos Authorization to Release Medical Information Form – please download and have your patient complete this form to expedite the process of acquiring medical records for use by our staff and oncologists PET/CT Order Form– this form is needed for any patient who requires a PET/CT scan You can also access our online Provider Directory for more information on our physicians, including: Phone numbers Specialties Board certifications Research interests And more COVID-19 Update To Our Referring Providers: To protect the health of our communities and as a safety precaution to prevent the risk of spreading COVID-19, Karmanos Cancer Institute is continuing visitor restrictions. See the visitor policy here. While COVID-19 presents a new challenge, our staff is equipped to handle events of this nature. We are doing everything possible to keep our patients safe. Learn more about Safe Care at Karmanos here. Thank you for your support and understanding as we continue to navigate this challenge. Sincerely, Karmanos Cancer Institute Health Team About Karmanos Audience Navigator HEADQUARTERS Karmanos Cancer Institute 4100 John R Detroit, Michigan 48201 Contact Us © 2021 All rights reserved. McLaren Health Care and/or its related entity