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  1. Click ‘Get Form’ to open the document in the editor.
  2. Begin by filling out the 'Referring Physician Information' section. Enter the referring physician’s name, date, office address, NPI number, city, state, ZIP code, and phone number.
  3. Next, complete the 'Patient Information' section. Input the patient's Mayo Clinic number, social security number (for informational purposes only), full name, address, county (optional), home phone number, sex (select either male or female), alternate phone number (mobile or work), maiden name (optional), and birth date.
  4. Indicate if the patient requires an interpreter by selecting 'Yes' or 'No.' If yes, specify the language needed.
  5. In the 'Appointment Request' section, provide a detailed reason for referral along with any pertinent medical records and insurance card if available. Specify the specialty requested.
  6. Once all fields are completed accurately, review your entries for correctness before submitting.

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And youll hear often that, Mayo Clinic receives more appointment requests than they can grant, so unfortunately they cant fulfill all requests. There are many stories here, one person wrote theyd walk on broken glass to get established at Mayo (and did), and many others who were not so lucky.
You can self-refer for a second opinion or ask your oncologist for a referral to Mayo Clinic. You can start this process from our website. Most questions about how to self-refer are answered in these Frequently Asked Questions.
Mayo Clinic, Rochester, Minnesota Phone: 800-533-1564 (toll-free) Fax: 800-321-1368 (toll-free) From outside the U.S.: 507-538-1515 (phone) or 507-538-7802 (fax)
You can call us at 1-855-392-8400 to confirm necessary information for the referral, and route your request and records to the appropriate department for review.
Phone: 855-776-0015 (toll-free). This number is answered from 7 a.m. to 6 p.m. CST, Monday through Friday.

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Specialties A. Addiction Treatment (Substance Abuse) Care for people with alcohol and other drug addictions. B. Bariatric Surgery (Weight-loss Surgery) C. Cardiac Rehabilitation. D. Dermatology. E. Emergency Medicine (Trauma) F. Family Medicine. G. Gastroenterology Hepatology (Digestive Care) H. Hematology (Blood)

Related links

Referring Physicians Web Fax Form - MC0688-04

Thank you for referring your patient to Mayo Clinic. Rochester, Minnesota. Phone Domestic. 800-533-1564. International +1-507-738-4021. Fax. Domestic. 800-321-Read more

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Record History | ver. 3: 2011-01-20 | NCT00964379

Mayo Clinic. Contact: Contact. Bruce Wolff, MD; 800-533-1564; wolff.bruce@mayo.edu. Principal Investigator. Bruce G Wolff, MD. IPD Sharing. IPD informationRead more

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533, RPIc, ribose-5-phosphate isomerase, ru5pD[c] r5p[c], rt4920, -1000 800, ACALDtce, acetaldehyde transport, acald[e] acald[c], -1000, 1000, 0Read more

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