Get Mayo Clinic Referral Form

Completing the Mayo Clinic Referral Form online is a straightforward process that enables you to refer a patient efficiently. This guide provides detailed steps to ensure you fill out all required fields accurately and submit the form successfully.

Follow the steps to complete the form with ease.

1. Click 'Get Form' button to obtain the referral form and open it in your browser.
2. Enter the referring physician information in the designated fields, including the physician's name, date, email address, office address, NPI number, city, state, ZIP code, and phone number.
3. Fill in the primary care physician's name if applicable.
4. Provide the patient information, including their Mayo Clinic number, full name, sex, address, county (optional), city, state, ZIP code, home phone, alternate phone, birth date, parent's name (if patient is a minor), maiden name (optional), and spouse's first name (optional).
5. If available, enter the patient's insurance information.
6. Indicate whether the patient requires an interpreter by selecting 'Yes' or 'No.'
7. If applicable, specify if the request is related to a motor vehicle accident, litigation, or worker’s compensation.
8. Detail the reason for the referral, including specific symptoms or diagnosis, and mention any pertinent medical records to be submitted.
9. Select the specialty requested for the referral.
10. Once you have filled out all the necessary information, save your changes, download a copy, print it, or share the form as needed.

Start filling out the Mayo Clinic Referral Form online today for efficient patient referrals.