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
- GI Consult Request
- Hepatology Consult Request Form
- IBD Clinical Trials Referral Form
- Physiology testing (including breath testing) (internal only)
Oral & Maxillofacial Surgery Referral Forms
- Hospital-Based and Special Care Dentistry
- OMFS at Michigan Medicine
- TMD/Orofacial Pain
- Wisdom Tooth Clinic Referral
Transplantation
Additional Forms
- Allergy Outpatient Consult Form
- Cardiac CT Form
- CT Questionnaire (internal only)
- ECHO Questionnaire
- Metabolism, Endocrinology & Diabetes (MEND) Outpatient Consult Request
- Methacholine Challenge Patient Preparation Form
- MRI Questionnaire (internal only)
- Nephrology Outpatient Consult Form
- Neurosurgery Consult Request Form
- Oncology Service Consult Request Form
- Outpatient Endocrine Dynamic Testing Request
- Outpatient Referral Request for Interventional Pulmonology Services
- Pediatric Pulmonology External Referral
- Pulmonary Division
- Rheumatology Request for Consultation