Professional Referral Contact Form
Submit professional contact details and general service interest so Loving Private Care 71 can follow up directly.
Professional referrals only. Do not enter protected health information in this form.
Do not submit client names, dates of birth, diagnoses, medical records, service addresses, insurance identifiers, or other PHI. For secure documents, fax (248) 595-8639 or call (313) 735-5298.
What to Submit
- Facility or organization name
- Your name and professional title
- Direct phone number and work email
- General service interest only
After submission, a member of Loving Private Care 71 will contact you to discuss the general referral need and the appropriate secure next step.
Secure Document Alternatives
Secure fax: (248) 595-8639
Phone: (313) 735-5298 · Text: (313) 735-5298
