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Appointment Request Form

To request an appointment please complete the following form. You may also schedule an appointment over the telephone by dialing (617) 726-7500 Monday through Friday, 9 a.m. to 4 p.m. Eastern time.

If your injury is the result of an auto or work-related accident, or if you are seeking free care, please call our front desk at (617) 726-7500.

In the case of a medical emergency, call 911 or head directly to your nearest hospital emergency room.

Fields marked with an asterisk (*) are required—you cannot submit the form unless these fields are completed.

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ex. xxx-xx-xx

(If you do not have an MGH Blue Card, or if you need to update your insurance information, please call the MGH Registration Division toll-free at 866-211-6588 before submitting this form).
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*  ex. xxx-xxx-xxxx
 ex. xxx-xxx-xxxx
 ex. xxx-xxx-xxxx
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Please double-check all of your information before you submit this form.
 

You will be contacted by the Sports Medicine Service with scheduling information.

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