Refer a patient to Michigan Orthopaedic Surgeons.

Thank you for choosing Michigan Orthopaedic Surgeons. As the largest and most comprehensive orthopaedic team in the state, we’re proud to partner with providers like you – helping patients go beyond their pain.

To refer a patient, please fill out the following form. Within 24 hours, we will reach out to them directly to schedule an appointment with an expert. (Note: If, for some reason, we have not called within 24 hours, we will call as soon as we can.)

Referring Office Information
Referring Physician*
Phone Number*
Email Address*
Fax Number (optional)
If you would like a confirmation of your patient’s appointment, please provide your fax number.
Patient Information
Patient Name*
Date of Birth*
Phone Number*
Alternative Phone Number
Email Address
Patient Insurance
Does this visit relate to a workers' compensation claim?
- Yes
- No
Patient Has Completed
- Bone Scan
- CT Scan
- CT Scan
- EMG
- X-Rays
- Cast/Splint Applied
Enrollee ID
Group ID
Comments
This field is for validation purposes and should be left unchanged.

If you are a patient interested in making an appointment, save time and schedule online.

Refer a patient to Michigan Orthopaedic Surgeons.

Referring Office Information

Patient Information