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Schedule a Test

Please complete the following form below to request an appointment at St. Joseph Mercy Oakland. We will call you within one business day to schedule your appointment.Ā Please use this form only for non-urgent requests.

If you are having an emergency, call 911 or go to your nearest emergency room. 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 you have questions please call 248-858-3777.

* Indicates required information
Patient Information 
First Name * 
Last Name * 
Street Address * 
City * 
State * 
Zip * 
E-mail Address * 
Phone Number * 
Best time to contact you * 
Date of Birth *  (mm/dd/yyyy)
Patient Gender * 
Insurance Information * 
Procedure Name * 

If Other, please specify:

Preferred Day(s) for Appointment 
Name of Physician Requesting Exam/Test * 
Reasons for Appointment (If possible, include diagnosis and/or symptoms) * 
Additional Information 
Authentication * 

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St. Joseph Mercy Oakland | 44405 Woodward Avenue, Pontiac, Michigan 48341 | 248-858-3000