If you are a Mayo Clinic alumnus or alumna and would like to refer someone who is NOT your patient, please fill out
the form below.
Note that the person you are referring must be aware that you are making the referral so that patient scheduling
representatives can contact the prospective patient. This information will be forwarded to the appropriate Mayo Clinic scheduling team, who will reach out to the
potential patient directly. This is a service for alumni but does not guarantee a consultation for the individual.
Please have the following patient information available (when referring your own patient)
Patient’s given (legal) name; if female, maiden name (if available)
Name of insurance provider and type of plan (HMO or PPO)
Whether the reason for referral is related to litigation, a motor vehicle accident, workers’ compensation or other liability
National Provider Identifier (NPI) or Unique Physician Identification Number (UPIN) of the referring physician
Diagnostic information (symptoms, tests performed and duration of patient’s medical concern)
Tips for referring a patient
Please keep the following in mind as you consider making a patient referral:
Patients with back pain must meet Mayo Clinic triage criteria for an appointment. This triage will occur during the phone call. If the patient does not meet Mayo Clinic triage criteria for an appointment, alumni may request to be connected to a Mayo Clinic physician for more information.
Patients with unsolvable, lingering chronic pain (longer than six months) are often not pleased with a referral to Mayo Clinic — or their referring physician — when no help can be offered.
Patients with chronic pain or those seeking a second opinion should be prepared ahead of time that there may be no further treatment options.
How are we doing?
We always are looking for feedback about the patient referral process. If there is anything you would like to share with us about how we can make this experience better, please contact the Mayo Clinic Alumni Association office at firstname.lastname@example.org.