MHC is a referral-based program meaning we need a referral from a provider to submit to insurance and to start treatment. Unfortunately, we do not accept walk-in patients.

Below are Referral Forms for each of our four centers. Please download the form from the center you wish to receive treatment at, fill it 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