Request a Test

Complete the form below and click Send Appointment Request. A scheduler will call you within the next business day to schedule your appointment. Use this form only for non-urgent requests.

*Indicates required field

Appointment Information

Beaumont offers testing in a variety of locations. Depending upon the test your doctor has ordered and your medical history, your choice of testing sites may be limited. To schedule an exam, you must have a written order from your doctor. Refer to your doctor's order to select the test you wish to schedule from the list below.

If the test or procedure you are seeking is not listed, please call the Appointment Center (1-800-328-8542) weekdays between 8 a.m. and 8 p.m., Saturday between 8:30 a.m. and 1:30 p.m. (The Appointment Center is closed holidays.)

Add a Test/Procedure to this appointment request

Select a test/procedure*

Select a location

Selected tests/procedures

None selected

Preferred Time of Day for Appointment:

Patient Information

Patient's First Name: *

Patient's Last Name: *

Requestor's Name:

(if different than patient)

Preferred Phone: *

XXX-XXX-XXXX

Best time to call:

Alternate Phone:

XXX-XXX-XXXX

E-mail:

Patient's Birth Date:

Patient's Gender:

Male

Female

Patient's Address:

City:

State:

ZIP Code: