Request a Cancer Appointment

Henry Ford Cancer Institute nurses are available 24 hours a day, seven days a week to provide support, answer your questions and guide you to the care you need. Call (888) 777-4167 to speak to one of our nurses or fill out this request form and a cancer nurse will contact you within 24 hours.

* Asterisk indicates required field.

First Name

Last Name

E-mail

Phone Number

Address

City

Zip Code

Date of Birth

(mm/dd/yyyy)

How do you prefer we contact you?

Email
Phone

When do you prefer we contact you?

Reason for request

Please provide any additional information

Select one:

I do not have images
I have my images on CD/DVD/other media, and can upload them to Henry Ford Health System
I authorize Henry Ford Health System to contact a designate to secure my images/exams

If you selected Option 3 above, who should we contact to obtain images on your behalf?

Provide name and contact information here

Authentication

Connect with our Cancer Team 24/7

Call us at (888) 777-4167

Connect with a Cancer Expert

Clinical Trials

Discover hundreds of clinical trials for virtually all types of cancer.

Cancer Support Services

Emotional, physical and spiritual services help guide your treatment and recovery.

Cancer Institute

Start here to explore full range of care available at the Henry Ford Cancer Institute.

Featured Locations Search All Locations

Browse Locations by Type

Featured ServicesSearch All Services

Browse Services by A-Z

Log in to MyChart

Henry Ford Health System

Caring For You

Research & Education

Request a Cancer Appointment

Clinical Trials

Cancer Support Services

Cancer Institute