Please use this form only if:
  • You have never been a patient in the Hip & Knee Center, OR
  • You have been a patient in the HIp & Knee Center but are seeking an appointment with a new clinical area or doctor

A representative will be in touch with you to confirm the details of your appointment. To make an appointment by phone or if this is an urgent request, please call 617-726-8575.

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








Referring Physician



About Your Appointment







200 character limit