Get 800 533 1564

Completing the 800 533 1564 form online is a straightforward process that requires careful attention to detail. This guide aims to assist users in effectively filling out the form while ensuring all necessary information is accurately provided.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the referring physician information. This includes the referring physician's name, date, office address, NPI number, city, state, ZIP code, and phone number.
3. In the patient information section, provide the patient's Mayo Clinic number, social security number (for informational purposes only), full name (first, middle initial, last), address, county (optional), city, home phone, sex (male or female), alternate phone (mobile or work), maiden name (optional), and birth date.
4. If the patient is a minor, include the parent’s name. If necessary, indicate whether the patient needs an interpreter and specify the language.
5. In the appointment request section, clearly state the reason for referral, any symptoms or diagnosis, and submit any pertinent medical records and the patient’s insurance card if available. Specify the specialty requested.
6. After reviewing all entries for accuracy, users can save changes, download, print, or share the form to ensure it is submitted correctly.

Take the next step and fill out the 800 533 1564 form online today!