Request an Appointment

Please use this form only if:

• You have never been a patient in the Kidney Transplant Program, OR
• You have been a patient in the Kidney Transplant Program but are seeking an appointment with a new clinical area or doctor

Your first appointment will be a comprehensive pre-transplant evaluation that includes medical and surgical consultations, laboratory tests and specialized procedures to determine if you are a candidate for transplantation. Before we can schedule your pre-transplant evaluation, you will need to do the following:

• Submit the secure form below
• Obtain a Mass General Medical Record Number (MRN) — If you have not received care at Mass General in the last six months, or if you have never received care at Mass General, please call 1-866-211-6588 (toll free) to verify your information and/or obtain an MRN. 

After you submit the form, a kidney transplant nurse coordinator and a transplant nephrologist will review your information and call you back with the information you’ll need to make an appointment. You may also speak with a representative directly Monday–Friday, 8:30 am to 5:00 pm EST by calling 877-644-2860.

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.