Refer a Patient

Thank you for your referral to the Henry Ford Health System. A representative will respond to your request the same day if it is received by noon and next business day if after. If you need faster service, please call the Referring Physician Office at 1-877-434-7470 for assistance.

* Asterisk indicates required field.

Referring Physician Information
*
*
*
*
*
*
Communication Preference


*
*
*
Gender

*
*
*
*
*
*
(mm/dd/yyyy)
*
*
Is this insurance an HMO?

*
Is this related to a work injury?

*
Will an interpreter be required

*
Appointment Information
*
(Please be specific and state area of involvement)
*
*
 

Schedule Appointment Online

Please call 911 if you have an emergency or urgent medical question.

Already a Henry Ford patient?
For the best experience, existing Henry Ford patients can request and self-schedule appointments through Henry Ford MyChart.

Henry Ford Health System is committed to ensuring our Deaf or hard-of-hearing patients and visitors have equal access to all services. We provide the appropriate auxiliary aids and services, including qualified sign language interpreters, TTYs and other assistive listening devices, at no cost. To request assistance, call 313-916-1896 or email [email protected].

Schedule Appointment for