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

If you are having an emergency, call 911 or go to your nearest emergency room. Please do not utilize this scheduling feature for urgent medical situations.

For your safety please call our MyCare Advice Line at 844-262-1949 before scheduling if: You currently have a temperature greater than 100.4 degrees Fahrenheit. In the past 21 days you have been diagnosed with COVID-19. In the past 14 days you have had contact with anyone diagnosed with COVID-19. Or If you have experienced two or more of the following symptoms in the last 3 days: fever, chills, drenching sweats, new cough, loss of taste/smell, shortness of breath, body aches, headache, sore throat, runny nose or nasal congestion, nausea/vomiting/diarrhea.

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 CommunicationAccess@hfhs.org.

Schedule Appointment for