Please submit the secure form below to refer your patient to a provider in the Kidney Transplant Program at Massachusetts General Hospital.

To expedite the intake process, please encourage your patient to call the Mass General registration at 877-716-8440, Monday-Friday, 8:30 am to 5:00 pm EST.

* indicates a required field.

Patient Information





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If on dialysis, 2728 form must be included in referral submission.





Referring Physician



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Preferred Method of Communication

Physician Gateway is our secure online portal allowing real-time access to your patients’ medical record. Physician Gateway enables you to submit referrals for patients, monitor patient status and order imaging tests. 

To learn more or to enroll, please visit the Physician Gateway.

If you would like to schedule Provider Education or Transplant Referral Process training for your team, please contact Stacy Jean-Claude at 617-726-0037 or by email at sjean-claude@mgh.harvard.edu.