Complete the form below and choose “Submit”. Alternatively, you may download, print and mail a completed copy of the Treatment Referral Slip (PDF) to:

CompOne Administrators
PO Box 8023
Novi, MI 48375

If you need a paper copy of your submission, please print the PDF and fill out with your information. If you choose to submit via the online form, your information is secure and sent directly to the CompOne team, but you will not receive a paper copy of your submission.