- Massachusetts General Hospital, Boston, MA

If you do not have a Mass General medical record number, you will need to call 1-866-211-6588 to register and obtain one.

Name*

Gender*

Street Address 1

Street Address 2

City

State

Zip

Date of birth*

Email address

Contact phone number

MGH Medical Record Number (if known, otherwise enter none)*

Program you are interested in

Is there a specific physician you would like to see?

Choose your desired location

Please describe your medical condition*

Request an Appointment