Please use this form only if:
  • You have never been a patient in the Orthopaedic Trauma Center, OR
  • You have been a patient in the Orthopaedic Trauma Center 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. If you were seen in the Emergency Room and/or have an urgent appointment request, please call 617-726-9111.

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

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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


Referring Physician

About Your Appointment


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