By completing the form on this page, you can send us a secure message that will be answered by our International Services Center staff. Every effort will be made to respond to your request within two business days.

If you need to speak to someone immediately, please call the International Services Center at (713) 704-5515 or toll-free at (800) 790-7890. Our office hours are Monday through Friday from 8 a.m. to 5 p.m. Central Standard Time (USA).

Required Documentation

Please note the required documents needed to process your Appointment Request. These may be faxed to our office at (713) 704-6493.

  • Patient's personal information:
    • Full name, date of birth, home address, native country, home and work telephone in native country (city and country codes), fax, cellular, e-mail, emergency contact name and telephone number
    • Financial responsibility: self-pay, letter of guarantee, International Insurance
  • If patient is a child (18 years of age and under):
    • Name of Guarantor and/or Legal Guardian
    • Guarantor and/or legal guardian dates of birth, contact information and financial responsibility
  • Medical history documentation (English preferred):
    • Diagnosis
    • Medical reports supporting diagnosis
    • Referring physician and contact information
    • Copies of radiology films, lab work, physician notes, current medications and past surgeries

Contact Us

If you are an international patient wanting to visit Memorial Hermann, please fill out the form below, and we will contact you.

This form is for international patients only. If you are a resident living in the United States, please fill out our main contact us form here.


Thank you for contacting Memorial Hermann. We have received your inquiry, and a team member will contact you soon.

If you need more immediate assistance, please call us at (800) 790-7890.

If you are experiencing a medical emergency, call your local emergency services or go to the nearest emergency room.

International Services