Request an Outpatient appointment

Please submit the secure form below to refer your patient to a provider at Massachusetts General Hospital.

The Mass General
Referral Portal

The Mass General Referral Portal is a secure online dashboard to make referrals and monitor patient status. Available 24/7, this free service will help you with ongoing management of your referrals and make the transition of patients back into your care as smooth as possible.

Learn more and register (Opens in a new window)

Please use the form below to request a new patient appointment with one of our providers. This form should not be used for appointments needed within 72 hours; in those cases, please call us at 855-477-4755.

After you submit this form, Massachusetts General Hospital staff will work directly with the patient to schedule an appointment and assist with registration if needed. Referring providers will be notified of appointment details.

If you prefer to make this referral by phone or have questions, our staff in the Referral Management Office is available to assist you Monday through Friday,
8:30 am-5:00 pm, at 855-477-4755.

 

 

 

 

Required fields are marked with an*

Referring physician first and last name*   

Referring physician NPI#*   

Direct phone number for referring physician*   

Referring physician email address*   

Referring physician fax number*   

Referring practice name*   

Referring practice mailing address*   

Preferred method of communication for status updates*   

Are you the referring physician?*   

Your name (if you are not the referring physician)

Is the patient aware of this referral?*   

Preferred Mass General provider or specialty*   

Patient first and last name*   

Patient birth date*   

Patient phone number (to contact the patient with appointment information)*   

Reason for visit*   

Check the box if you would like to be registered for the Mass General Referral Portal, a secure online site to make referrals and monitor patient status. You will receive a confirmation email with login information within 24 hours.  



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