Request a Room

The Ronald McDonald House is happy to take your room request on-line. Please fill out the request form below and someone from our staff will get back to you as soon as possible.

Special Note:  The Ronald McDonald House of Western Michigan does not house families of patients receiving outpatient psychiatic treatment.

Are you a ...?*	Guest Referral Source
Check in Date: *
Check out Date (if known):
Estimated time of arrival:
(We prefer that all guests check in before 8 p.m. Please note, all guests must check in before 9 p.m. If special circumstances arise, please call the on-duty manager at 616-776-1300.)
Are you a ...?	New Guest Former Guest
Guests' First Name:*
Guests' Last Name:*
Birthdate:*
Address:*
City:*
County:
State:*	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Home Phone:*
Cell Phone:*
Email Address:
Relationship to patient :*
Please list all the names and birthdates of persons that will be staying at the WMRMH
Additional Guest 1 Name:
Additional Guests 1 Birthdate:
Additional Guest 2 Name:
Additional Guests 2 Birthdate:
Additional Guest 3 Name:
Additional Guests 3 Birthdate:
Additional Guest 4 Name:
Additional Guests 4 Birthdate:
Patient's First and Last Name:*
Birth Date*
Hospital or Program: *
Unit/Clinic: *
Inpatient or Outpatient treatment: *	Inpatient Outpatient
Are there any special needs of anyone who will be staying with us? (ie cribs, car seats, etc.): *
Name of person referring guest to RMH: *
Referral's occupation: *	Nurse Social worker Doctor Other
Phone number of person referring guest: *
Email Address of person referring guest:*
	Enter the letters you see above (not case sensitive):*