What type of appointment are you requesting?

Please download and fax to us the form pertinent to the type of appointment request, as well as the Authorization to Request Medical Records form.

• New Patient Referral Form – this form is needed for any patient who requires a consultation with our oncologists
• Radiology Appointment Request Form – form is needed for any patient who requires a mammogram, ultrasound or any other type of radiology service offered by Karmanos
• Authorization to Release Medical Information Form  – please download and have your patient complete this form to expedite the process of acquiring medical records for use by our staff and oncologists

You can also access our online Provider Directory for more information on our physicians, including:

• Phone numbers
• Specialties
• Board certifications
• Research interests
• And more

If you have any questions, please call our Karmanos Concierge department at 800-KARMANOS (800-527-6266).