Please fill out the form below to request an appointment with Massachusetts General Hospital's Division of Surgical Oncology.

  • You may also schedule an appointment by phone: 617-726-5507

Thank you for contacting the Division of Surgical Oncology at Massachusetts General Hospital. Once we have received your completed form, our office will contact you within one business day to schedule an appointment.

If you have never been a patient at Mass General, please call Patient Registration at 866-211-6588 to register after submitting this form. After registering, you will receive a Mass General medical record number. A medical record number is our way of tracking patient information, including insurance providers and important contact information.

Required fields are marked with an*

Patient name*   

Date of birth*   

Preferred phone number*   

Email address

Please provide a brief description of your condition and any information you think may be important for us to know, including primary care or referring physician information and previous testing (if any):*   

How did you hear about us (new patients only)?

If you answered "other" to the question above, please specify: