Request an Appointment

This form is for non-urgent appointments only. Appointment requests are processed in one to two business days.

  • Existing Henry Ford patients should request an appointment through MyChart
  • Log in to MyChart

  • If you do not have a MyChart account, sign up now
  • If you are having an emergency, call 911 or go to your nearest emergency room
  • Request a same-day primary care appointment
  • Call us:
    • Southeast Michigan Patients: (800) 436-7936
    • Jackson or South Central Michigan Patients: (517) 205-4800
How Can We Help You?
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Patient Information
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Enter MM/DD/YYYY format
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Insurance Information
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Contact Name
 

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