Living-donor appointment request

Complete the form below to start the process of becoming a living kidney donor at Mayo Clinic Florida.

Only people living in the United States should use this form. If you live elsewhere and are interested in becoming a living donor, please email us including your full name, date of birth (MM-DD-YYYY), telephone number, city, country, time zone and preferred language if not English. A scheduler will call you, with an interpreter if appropriate, to register you as a potential living donor.

All fields are required unless marked optional.

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Donor Information
Have you previously received care at Mayo Clinic?

Donor's information should be as it appears on driver's license or legal documents. For example, if a donor goes by Bob, but his legal name is Robert, enter Robert.

Preferred phone type