Please provide the following information to help your Mayo Clinic care team assess your medical needs. When you have filled out and submitted this form you will be contacted by the Nicotine Dependence Center to review your registration request and explain additional program details.
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:
¿Te gustaría hacer una donación deducible de impuestos y ser parte de una investigación de vanguardia y de una atención médica que transforma la medicina?