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Information that will be needed in order to process the referral include: Web in order for us to provide the best possible patient care, expedite the referral process, and schedule an appointment for your patient, we need your assistance. Web ibd clinical trials referral form; Your referral relationship with the university of michigan rogel cancer center is highly valued. Web fax completed form directly to the clinic fax number provided (optional) 03/28/06 v.8. Address of care and phone numbers; Please fax or send electronically the information listed below to the appropriate clinic. Type and start of therapy That is why we're dedicated to developing and maintaining referring physician satisfaction. Users, this site has been optimized to work with the following browsers: Please use/download one of these approved browsers.
