Refer a patient to the Division of Gastroenterology using our online form.

  • For URGENT outpatient referrals, please call 617-726-2426
  • For URGENT inpatient referrals, please page the GI Physician on call at 617-726-2241

Refer a patient to the Division of Gastroenterology using our online form.

Required fields are marked with an*

Patient Name*   

Patient Gender*   

Patient Date of Birth*   

Patient Phone Number*   

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

Referring Physician Name*   

Referring Physician Phone Number*   

Referring Physician Email Address

Program you are interested in:

Is there a specific physician you would like to refer to?

Choose your desired location

Please describe the reason for the referral*