COVID-19 Spotlight: For Health Providers part 2
Please visit the For Health Providers page for a coronavirus update message from Michigan Medicine.
Consult Request Form
Referring Physicians can now complete a Consult Request Form to request an appointment with our specialty clinics. This online form was especially designed to allow you to request appointments at your convenience.
Radiology Requisition
U-M Radiology Services are available at our hospitals and outpatient facilities in various communities. For detail, view Radiology Services by Location.
GI/Hepatology Referral Forms
- Direct Access Capsule
- Direct Access Endoscopy Referral
- Direct Access EUS Referral Form
- FibroScan Request Form
- Hepatology Consult Request Form
- GI Consult Request
- IBD Clinical Trials Referral Form
- Liver Transplant Referral Form
- Physiology testing (including breath testing) (internal only)
Oral & Maxillofacial Surgery Referral Forms
- Wisdom Tooth Clinic Referral
- TMD/Orofacial Pain
- Hospital-Based and Special Care Dentistry
- OMFS at Michigan Medicine
Additional Forms
- Cardiac CT Form
- CT Questionnaire (internal only)
- ECHO Questionnaire
- Oncology Service Consult Request Form
- MEND Outpatient Consult Request
- Methacholine Challenge Patient Preparation Form
- MRI Questionnaire (internal only)
- Nephrology Outpatient Consult Form
- Outpatient Referral Request for Interventional Pulmonology Services
- Pulmonary Division
- Rheumatology Request for Consultation