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Request an appointment (International)

If you are a U.S. resident, please go to appointment information.

All fields are required unless marked optional.

Requester Information

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Patient Information

Please provide patient information as it appears on the passport.
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Gender:
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The name of a parent is required if the patient is under the age of 16.

If English is not the patient's primary language, we strongly encourage use of a Mayo Clinic interpreter. Mayo Clinic provides free interpretive services to non-English-speaking patients during their clinic appointments.
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Which of the following will the patient need assistance with?
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Patient Insurance Information


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Medical Concern
In the process of scheduling an appointment, you may be asked to send a recent medical summary in English including diagnosis, pathology reports and local physician's treatment plan. We will contact you regarding when and how to send this information. Please do not send X-ray films.
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Appointment Information

Please plan on five to eight business days to complete your appointments.

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Referral Information

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Important: After submission, please do not leave this form until you see the confirmation message.

Mayo Clinic Number

Your Mayo Clinic number is a 7, 8 or 9-digit number we assign to you as a new patient prior to your first visit. You can find it near the top of a range of documents, including pre-visit questionnaires, clinical notes, care summaries, and correspondence.

If you do have Mayo paperwork handy, it's often quickest simply to look for it there. Scroll down to see some examples of how the number shows up:

In correspondence:

Image of Form: Authorization for Mayo Clinic to Disclose Protected Health Information

In pre-appointment questionnaires

Image of Form: Authorization for Mayo Clinic to Disclose Protected Health Information

In medical documents:

Image of Form: Authorization for Mayo Clinic to Disclose Protected Health Information

In dismissal summaries:

Image of Form: Authorization for Mayo Clinic to Disclose Protected Health Information

In several other kinds of documents:

Image of Form: Authorization for Mayo Clinic to Disclose Protected Health Information

مكاتب المواعيد الدولية

  • Mayo Clinic في أريزونا
    480-301-7101
    480-301-9184 (فاكس)
    الاتصال على الهاتف المجاني من المكسيك: 001-800-010-1390
    Intl.mcs@mayo.edu
    ساعات المكتب: من 8 صباحًا إلى 5 مساءً بتوقيت ماونتن القياسي، من الاثنين إلى الجمعة
  • Mayo Clinic في فلوريدا
    904-953-7000
    904-953-7329 (فاكس)
    Intl.mcj@mayo.edu
    ساعات المكتب: من 8 صباحًا إلى 5 مساءً بالتوقيت الشرقي من الاثنين إلى الجمعة
  • Mayo Clinic في مينيسوتا
    507-284-8884
    507-538-7802 (فاكس)
    Intl.mcr@mayo.edu
    ساعات المكتب: من 7:30 صباحًا إلى 5 مساءً بالتوقيت المركزي، من الاثنين إلى الجمعة

إحالة الأطباء: يُرجى استخدام خدمات إحالة الأطباء الخاصة بـ Mayo Clinic.

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