MHC is a referral-based program, so we need a referral from a provider to start treating. Below are referral Forms for each of our centers. Please download, fill out, and fax to the number listed on the bottom of the page. Thank you for considering MHC for the treatment and care of your patients.

Euclid Hospital

• Download MHC Euclid Referral Form

Medina Hospital

• Download MHC Medina Referral Form 

Southwest General Hospital

• Download MHC Southwest Referral Form 

Parkwest Medical Center

• Download MHC Parkwest Referral Form