History & Referral Forms
Client Information Forms & Health Care Provider Referral Forms required to apply to the
Michigan Abilities Center are provided below in a Microsoft Word format, with the expection of
the Prescription Form, which is a PDF file. The PDF file can be opened using Adobe Reader, which
may be downloaded free by clicking the link below.
Client Information Forms
(please complete the forms listed below*)
Health Care Provider Referral Forms
(please have your physician complete the forms listed below*)
*Please send the completed participant's and physician referral forms by mail, email, or fax to:
Michigan Abilities Center7286 W. Ellsworth Road
Ann Arbor, MI 48103
Phone: (734) MAC-9500
Fax: (734) MAC-9555
Email: MACinfo@MichiganAbilitiesCenter.org