Request an Appointment: Barrett’s Esophagus

Please fill out the form below to request an appointment and one of our access coordinators will contact you within two business days.

  • You may also schedule an appointment by phone: 617-726-0607

If you are experiencing a medical emergency, call 911 or go to your local emergency room.

If you are a new patient, you may provide the information below to request an appointment. Our Barrett's Esophagus Treatment Center access coordinator will ask you more about your condition and symptoms, and match you with the best-fitting Digestive Healthcare Center physician.

Patients can be seen at Mass General in Boston and at the Mass General/North Shore Center for Outpatient Care in Danvers, MA.

While requesting an appointment please also register to receive a medical record number by calling the Patient Registration and Referral Center at 866-211-6588.

If you are already a patient of a Digestive Healthcare Center physician, please call your physician's office directly if you wish to schedule another appointment.

Required fields are marked with an*

Patient Information

Name*   

Date of birth*   

Best contact phone number*   

Street address*   

City*   

State*   

Zip code*   

E-mail address

Mass General Medical Record Number (MRN)

Location (hospital/clinic) where your last endoscopy was performed

Date of last endoscopy

Name of gastroenterologist

Have you received a diagnosis of Barrett's esophagus?*   

If yes, were you diagnosed with dysplasia or cancer?

Have you had any prior surgeries involving the esophagus or stomach (fundoplication, esophagectomy, gastric surgery, etc.)?*   

If yes, please list each surgery

Have you had any prior endoscopic treatments for Barrett’s?*   

If yes, please check previous endoscopic procedures (choose all that apply)

Radiofrequency ablation (RFA)  
Cryotherapy  
Endoscopic mucosal resection (EMR)  
Photodynamic therapy  

Please check any current symptoms (choose all that apply)*

Heartburn  
Reflux  
Difficulty swallowing  
Pain with swallowing  
Nausea  
Vomiting  
Weight loss  
Please list any current anti-acid medication, dosage and frequency

Please select your preferred Mass General visit location