Request an Appointment - Houston Methodist Global Health Care Services

To request an appointment, please complete the form below or contact our medical referral specialists at +1.713.441.2340. If you submit a form, a representative will contact you by the next business day to discuss your appointment request.

To protect your privacy, all of our online forms are encrypted and stored in a secure location. Please note that while our forms are secure, any communication via e-mail may not be secure, so please consider that when selecting a way for us to contact you. If you select phone or e-mail as your preferred method of contact, every effort will be made to return your request by the next business day.

First name * Middle name Last name(s) * Country of origin * Are you currently in the United States? * Yes No Contact phone * Email address * Date of birth * Gender * Male Female Are you the patient? * Yes No Payor type * Self-Pay Letter of Guarantee Commercial Insurance Is there a specific doctor you are requesting? * Yes No If Yes, please provide name Patient status with this doctor New patient Established patient If No, do you prefer a female or male physician? Female Male No preference Specialty preference(s) * Reason for appointment(s) * How did you hear about Houston Methodist? * Billboard Brochure/Flyer Direct mail/Invitation Doctor/Medical professional Event Family/Friend Government/Embassy Insurance company Internet Magazine Newspaper Social media Other If Other, please specify Additional information, if any

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