If you or a loved one have mental illness or co-occurring disorder, Rose Hill Center offers long-term treatment you need for healthy recovery. Residents, family members, or treatment providers can start the admissions process and financial information completion.
To move forward in the admission process, please download and complete the forms below. Once the admission forms are complete, please sign and mail or fax them to:
Admission Department – Rose Hill Center
5130 Rose Hill Blvd. Holly, MI 48442
or Fax: 248-634- 7754
(For your convenience, these forms can also be filled out using the interactive PDF forms linked below. Complete the form as directed, save the file to your computer and then email it as an attachment to email@example.com.)
- Physician Referral – To be completed by the current attending psychiatrist and should include supporting documents (lab results and psychiatric evaluations). NOTE: If the Rose Hill applicant is hospitalized, this form should not be completed by the hospital psychiatrist but rather the treating psychiatrist prior to hospitalization.
- Benefit Contact Information – Must be completed as part of the application and can be done by either the applicant or the applicant’s family. Required documents listed under the heading “Necessary for Admission” must be mailed or faxed to Rose Hill Center. (Note: Be sure to copy both sides of any two-sided documentation, i.e., insurance card, driver’s license, etc).
- Resident Application – Completed only by the resident applicant (Note: if the applicant is too ill to complete this form, the Director of Admissions may determine that it is not required for admission).
- Release of Information – Should be printed out, signed and forwarded to the medical records department of any hospital where the individual has been treated for psychiatric diagnoses. We have provided this form although some hospitals may require that you use only their form. NOTE: Rose Hill’s Admissions Department is available to follow up with the hospital(s) after you have signed the release of information form and spoken with the medical records department. Please provide us with the name and phone number of the hospital along with the name of the medical records personnel with whom you spoke.
If the applicant is currently hospitalized, advise the hospital treatment team of your interest in Rose Hill Center prior to discharge and ask them to call Laura Mueller, Director of Admissions at 248-531-0341. We understand the critical time constraints of hospital admissions and discharges and can respond promptly to work with the hospital therapy team on plans for discharge to Rose Hill Center.
When seeking admission at Rose Hill Center, prospective residents have access to a variety of payment options. Our dedicated admissions team can describe these options in greater detail to help make this process as easy as possible. For more information, please contact us.
Standard methods of payment include:
- Private pay
- Combination of private pay and financial assistance grants
- Some health insurance may cover a portion of the charges
Important insurance memo from Ben Robinson, President & CEO
- Public pay, if provided by a mental health authority
Grants may be offered based on financial need and the availability of Financial Assistance funds. For further information and instructions, please read the Financial Assistance Application Procedures.