Henry Ford Health System

Appointment requests are usually processed within two business days. If you prefer to contact us by phone, call 1-800-436-7936.

This appointment request form is not intended to address urgent situations. In the event of any emergency, always call 911.

* Indicates required information
Name: * 
Date of Birth: * 
Email Address: * 
Phone Number: * 
Preferred Contact Method: * 
Medical Specialty: * 
Name of Doctor, if known: 
Reason for Appointment: *