Request an Appointment

For a medical emergency, call 911. If you think you are experiencing a mental health crisis or are contemplating acting upon thoughts of suicide, call 988 immediately.

If you are a legacy Henry Ford patient, use MyChart to schedule and request appointments for an easier experience. You may also fill out the form below, or call us for services in:

Southeast Michigan: (800) 436-7936
Jackson or South Central Michigan: (517) 205-4800

If you are patient at a former Ascension hospital or ambulatory care site in Southeast Michigan or the greater Flint area, find care now.

Complete the form to request an appointment

Please allow 2-3 business days for a response and additional time for requests sent during the weekend or holiday. This request is not for urgent or same day requests.

Have you ever been to a Henry Ford location? Reason for Appointment Specialty Doctor's Name (if known) Preferred Dates and Time Preferred Location First Name Last Name Date of Birth Address City State/Province Zip code/Postal Code Phone Email Address Insurance name and subscriber number Contact Name Authentication

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Request an Appointment

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