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.

Former Ascension hospital or ambulatory care sites in Southeast Michigan or the greater Flint area, search by provider or search by location.

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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