Request an Appointment

You can use this form to request an appointment with Northline Women's Health Center. If you have a preference for a time of day or date for your appointment, please note this and allow one business day for a reply to confirm your request. If you are experiencing pain or symptoms, contact your doctor or 911 for immediate assistance. Please do not use this form to change and/or cancel your appointment or for medical questions.

Your Name
Please let us know your name.
Monday - 9:00 a.m. to 7:00 p.m.
Tuesday - 7:00 a.m. to 5:30 p.m.
Wednesday - 8:00 a.m. to 6:00 p.m.
Thursday - 8:00 a.m. to 8:00 p.m.
Friday - 8:00 a.m. to 1:30 p.m.
Your Email
Please let us know your email address.
Phone number
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Are You An Existing Patient?
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Office Location
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Preferred time
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Preferred date
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Please let us know your message.

Northline Women's Health Center Locations:

15675 Northline Road

Southgate, MI 48195

(734) 282-3600
(734) 282-3603 - Fax

23050 West Road, Suite 210

Brownstown Twp., MI 48183

(734) 362-7000
(734) 362-7077 - Fax