Quality CareFind out why Mayo Clinic is the right place for your health care. Make an appointment.
Meet the StaffFind a directory of doctors and departments at all Mayo Clinic campuses. Visit now.
Research and Clinical TrialsSee how Mayo Clinic research and clinical trials advance the science of medicine and improve patient care. Explore now.
Visit Our SchoolsEducators at Mayo Clinic train tomorrow’s leaders to deliver compassionate, high-value, safe patient care. Choose a degree.
Professional ServicesExplore Mayo Clinic’s many resources and see jobs available for medical professionals. Get updates.
Give to Mayo ClinicHelp set a new world standard in care for people everywhere. Give now.
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.
Please identify the program in which you are requesting enrollment.
Note: Programs may be rescheduled due to participation requirements. If this occurs you will be notified and provided the opportunity to reschedule your participation.
Important: After submission, please do not leave this form until you see the confirmation message.
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: