Back to Refer or Transfer a Patient
Referral Forms for Health Providers
Referring physicians can use the Consult Request Form to schedule appointments with our specialty clinics. This form is designed for your convenience, allowing you to request appointments at any time.
Radiology Requisition
U-M Health Radiology Services are available at our hospitals and outpatient facilities in various communities. Find a Radiology Services location.
For More Information
Consult Request Form
Conveniently schedule appointments for your patients at a U-M Health specialty clinic
Specialty Clinic Referral Forms
- Allergy Outpatient Consult Form
- Cardiac CT Form
- CT Questionnaire
- Direct Access Capsule
- Direct Access Endoscopy Referral
- Direct Access EUS Referral Form
- ECHO Questionnaire
- FibroScan Request Form
- GI Consult Request
- Hepatology Consult Request Form
- IBD Clinical Trials Referral Form
- Interventional Pulmonology Outpatient Consult Request
- Kidney Transplant Referral Form
- Liver Transplant Referral Form
- Lung Transplant Referral Form
- Metabolism, Endocrinology & Diabetes (MEND) Outpatient Endocrine Dynamic Testing Request
- Metabolism, Endocrinology & Diabetes (MEND) Outpatient Consult Request
- Methacholine Challenge Patient Preparation Form
- Nephrology Outpatient Consult Form
- Neurosurgery Consult Request Form
- OMFS at Michigan Medicine
- Oncology Service Consult Request Form
- Outpatient Endocrine Dynamic Testing Request
- Physiology testing (including breath testing)
- Pulmonary Consult Request Form
- Rheumatology Request for Consultation
- TMD/Orofacial Pain
- Wisdom Tooth Clinic Referral
