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
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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