Please use this form only if:
  • You have never been a patient in the Department of Obstetrics and Gynecology; OR
  • You have been a patient in the Department of Obstetrics and Gynecology but are seeking an appointment with a new clinical area or doctor

After you submit the form, a representative will call you back with the information you’ll need to make an appointment. You may also speak with a representative directly Monday–Friday, 8:30 am to 5:00 pm EST by calling 800-711-4644.

Important note: Some questions on this form may appear or disappear based on your responses.

* indicates a required field.

Please call 911 if you are experiencing a medical emergency.

Requestor Information










If you are an international patient, please complete the International Patient Appointment Form.

Patient Information








MM/DD/YYYY








Appointment

Please note, the gynecology practice at Massachusetts General Hospital is a consultative practice. We are currently not accepting new patients for annual routine visits. Please contact your primary care physician.

If you are an international patient, please complete this form to be contacted by our International Patient Center.

Referring Physician



About Your Appointment