Use the form below to make an appointment with the Center for Metal-on-Metal Hip Replacement.

If you do not have a Mass General Medical Record Number, you need to call 1-866-211-6588 to register and obtain one before we can schedule your appointment. A manager will be in touch to schedule your appointment.

Required fields are marked with an*

Name*   

Date of birth*   

Phone number*   

Email address

Mass General Medical Record Number (Pre-registration required, call 1-866-211-6588)*   

What type of metal-on-metal hip replacement do you have?

When was the hip replacement performed?

Reason for visit

Additional comments

Insurance plan