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Request an appointment (U.S. residents)

Complete the form below to request an appointment at Mayo Clinic. An appointment representative will contact you within three business days to review your medical information before an appointment may be offered.

If you are having a medical emergency, call 911 or emergency medical help.

All fields are required unless marked optional.

Requester Information
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Please enter requester's legal first name.Name must begin with a character and no special characters afterward.
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Please enter requester's legal last name.Name must begin with a character and no special characters afterward.
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Please enter your primary phone number.Please enter a valid phone number.
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Primary phone type:
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(optional)Please enter a valid fax number.Please enter a valid fax number.
Please enter a valid email address.
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At which Mayo Clinic location are you requesting an appointment?
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Patient Information

Please provide patient information as it appears on legal documents.

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(optional)Please enter a valid Mayo Clinic number.Please enter a valid Mayo Clinic number.
Please enter the patient's legal first name.Name must begin with a character and no special characters afterward.
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(optional)Legal middle name: must have at least 0 and no more than 256 characters.Name must begin with a character and no special characters afterward.
Please enter the patient's legal last name.Name must begin with a character and no special characters afterward.
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(optional)Other name(s) used: must have at least 0 and no more than 256 characters.Name must begin with a character and no special characters afterward.
Please enter the patient's address.Please enter a valid address - only alphanumeric characters, #, and - allowed.
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Please enter the patient's city.Please enter a valid address - only alphanumeric characters, ' , and - allowed.
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Please enter the patient's ZIP code.Please enter a valid ZIP code.
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Primary phone is required.Please enter a valid phone number.
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Primary phone type:
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(optional)Secondary phone: must have at least 0 and no more than 256 characters.Please enter a valid phone number.
Secondary phone type:
Please enter a valid email address.
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(optional)Please enter a valid fax number.Please enter a valid fax number.
Gender:
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The name of a parent is required if the patient is under the age of 16.Parent name/Guardian name: must have at least 0 and no more than 256 characters.Name must begin with a character and no special characters afterward.
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Primary language: must have at least 0 and no more than 20 characters.The value of the Primary language: field is not valid.
Patient Insurance Information
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(optional)Please enter an insurance provider.Name must begin with a character and no special characters afterward.
(optional)Please enter an insurance identification number.Please enter a valid address - only alphanumeric characters, #, and - allowed.
(optional)Please enter a plan name.Name must begin with a character and no special characters afterward.
Medical Concern
Input is required and must be limited to 300 characters.
You have 300 characters remaining out of 300 total.
How long has the patient had this problem?
Input must be limited to 300 characters.
You have 300 characters remaining out of 300 total. (optional)

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

Appointments by Phone

Calls may be monitored or recorded for quality purposes.

  • Mayo Clinic in Arizona
    800-446-2279 (toll-free)
    8 a.m. to 5 p.m. Mountain standard time, Monday through Friday
  • Mayo Clinic in Florida
    904-953-0853
    8 a.m. to 5 p.m. Eastern time, Monday through Friday
  • Mayo Clinic in Minnesota
    507-538-3270
    7 a.m. to 6 p.m. Central time, Monday through Friday

International patients: Please use the international appointment request form.

Referring physicians: Please use Mayo Clinic's referring physician services.

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