REQUEST FOR SERVICE

Please include as much information as possible when filling out the form below. The assigned Case Manager will call you within 24 hours to discuss this case. Thank you

If you prefer you may print a copy of our Request for Service Form, fill out the information, and fax it to us at 1-616-363-5334.

View/Print Request for Service Form

MAKE A REFERRAL: For your convenience you can also make a referral to Starr and Associates via the
following methods:

  1. By calling our main office @ 616-363-4500
  2. By Faxing us @ 616-363-5334
  3. By emailing us at referrals@starrandassociates.net

If you are referring a Stokes Evaluation please include the following information with the referral.

  1. Recent medical records with all physical/psychological restrictions
  2. Form 105 if available
  3. Vocational records (resume, job application, job description)
  4. Wage records from the last employer.
  5. Criminal records, if any
Online Service Request Form:

MORE INFO

  • PHONE
  • Toll Free: 1-877-91REHAB (73422)
  • Direct Dial: 1-616-363-4500
  • Fax: 1-616-363-5334
  • HOURS
  • Monday – Friday
  • (Except all legal holidays)
  • 9am – 5pm
  • LOCATION
  • 601 3 Mile Road NW
  • Suite A
  • Grand Rapids, MI 49544