Forms & Applications
Download, print, and complete the forms below. Submitting forms in advance helps us serve you faster and more efficiently.
Patient Services
New Patient Application Form
Complete this form before your first visit. Includes personal information, insurance details, medical history, and consent for treatment.
How to submit
- 1Download and print the form
- 2Fill out all required fields completely
- 3Bring the signed form to your first appointment
- 4Or fax completed form to (313) 960-6605
Careers
Employment Application Form
Interested in joining our team? Download the employment application for clinical, administrative, and support positions at Home Comfort Dialysis.
How to submit
- 1Download and complete the application
- 2Attach your current résumé
- 3Email to [email protected]
- 4Or drop off in person at our front desk
Clinical & Insurance
Insurance & Referral Form
For physicians and referring providers. Use this form to submit patient referrals, insurance pre-authorization requests, and clinical documentation.
How to submit
- 1Download the referral/insurance form
- 2Complete all clinical and insurance fields
- 3Fax to our referral line: (313) 960-6605
- 4Questions? Call (313) 960-6605
Need help with a form?
Our staff is happy to assist you. Call us during business hours or send us a message and we'll get back to you promptly.