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

** Check with your insurance carrier for coverage limitations.

If you can't find a date/time that works for you please call the provider’s office. Not all appointment types at all locations are available online.

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.

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