Patient History Form

Please carefully read and complete the form to the best of your knowledge at least one week prior to your visit. Additionally, please mail, email or fax any relevant medical records (Mail: 2799 West Grand Blvd. K11 Department of NeuroSurgery Detroit, Michigan 48202; fax to (313) 916-7139 and bring any imaging disks for X-rays, CT scans, MRIs etc. with you to the appointment. Do not hesitate to contact us with any questions at (313) 916-2723.

* Asterisk indicates required field.

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Connect with the Neurofibromatosis Clinic

The only award-winning clinic of its kind in Michigan

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.

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.

If you have traveled to China, Iran, Italy, Japan or South Korea in the last 14 days or been in close contact with someone suspected to have the COVID-19 (Coronavirus), please contact our nurse line @ 313- 874-7500 prior to scheduling.

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