Request an appointment with our Sports Medicine doctors.

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.

This form should only be used for routine, non-urgent appointments. If you have an urgent request, please call our office at 617-726-7500.

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)*   

Referring Physician:*   

What is your injury or problem?*   

When did your injury/problem occur?*   

Is this a Worker's Compensation case?

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

Further describe your medical condition and ask other questions:

Insurance Plan: