Request an appointment with our Podiatrists.

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.

Please note: This form should only be used if you want an appointment on MassGeneral’s main campus in Boston. If you would like an appointment at one of the Health Centers, call them directly. Charlestown: 617-724-2270. Revere: 781-485-6000. Chelsea: 617-887-4149.

If you have an URGENT appointment request, DO NOT use this form to request an appointment. Call 617-726-3487 to 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 - please list the best number to reach you*   

Email address

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

Primary Care Physician

Did a physician refer you?  
Referring Physician

Appointments will be made with the first available podiatrist, but to request a specific podiatrist, list the name below

Check this box if you have diabetes  
Check this box if you have an open wound or infection on your foot  
Please describe the foot condition you are seeking an appointment for

Have you had x-rays taken related to your condition?  
If yes, were the x-rays done at MassGeneral?  
Have you had a CT scan related to your condition?  
If yes, was the CT scan done at MassGeneral?  
Have you had a MRI related to your condition?  
If yes, was the MRI done at MassGeneral?  
Have you had an ultrasound related to your condition?  
If yes, was the ultrasound done at MassGeneral?  
Check this box if you have had prior treatment for this condition  
Insurance plan