Consult Request FormÌý
Referring Physicians can now complete the Outpatient 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 .
C.S. Mott Children's Hospital Emergency Services
GI/Hepatology Referral Forms
For direct assistance to schedule appointments for patients who need urgent outpatient consultation with a specialty gastroenterologist.
Suzanne Taylor,ÌýRN
Phone:Ìý734-232-9424
Fax:Ìý734-936-5458
E-mail:Ìý[email protected]
- Direct Access Capsule
- Direct Access Endoscopy Referral
- Direct Access EUSÌýReferral Form
- FibroScan Request Form
- GI Consult Request
- Hepatology Consult Request Form
- IBD Clinical Trials Referral Form
- Physiology testing (including breath testing)Ìý
Oral & Maxillofacial Surgery Referral Forms
- Ìý
- Ìý
Transplantation
Additional Forms
- Allergy Outpatient Consult Form
- Cardiac CT Request Form
- CT Questionnaire (Outpatient)
- ECHO Questionnaire
- Neurosurgery Outpatient Consult Request Form
- Oncology Service Consult Request Form
- Pediatric Pulmonology External Referral
Ìý