YOUR INFORMATION, IF YOU ARE REFERRING SOMEONE TO PACE:

First Name *

Last name *

Relationship to the individual you are referring *

Phone

INFORMATION WE NEED ABOUT THE PERSON YOU ARE REFERRING, OR YOU, IF YOU ARE INTERESTED IN PACE FOR YOURSELF:

First Name *

Last name *

Date of Birth

Address

City

State

Zip Code *

Phone *

What PACE services are you interested in or what kind of assistance is needed?

Referral/Interest Form

Thank you for your interest in learning more about PACE North and/or referring a friend/client. We are eager to reach out to them and discuss our program and how we can help them get the care they need to live the life they want.
Fields marked with an (*)asterisk are required.

Referral Program

Last Updated: Nov. 4, 2026

PACE North

The Harry and Jeanette Weinberg—PACE Center
2325 Garfield Road North
Traverse City, MI 49686

Business Hours: M-F 8:00am - 5:00pm

Refer Now

Contact Us Today

Main Number: (231) 385-1498
Toll Free: (833) 410-2086
Toll Free Hearing Impaired (TDD/TTY): (833) 410-2082
Fax: (231) 252-3750

Referral/Interest Form

PACE North

Contact Us Today

Contract #H4256-02