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Appointment Scheduling for International Patients

Request an Appointment

Thank you for your interest in Mass General Brigham for your healthcare needs.  In order to best assist you, please complete the below form.  Once submitted, a member of our international services team will promptly contact you. 

Note: Some questions on this form may appear or disappear based on your responses

* indicates a required field.


Primary Contact
If you are completing the form for someone else, please include patient's primary contact's information below. 






Country and City Code

Patient Information











Patient Information, Continued







International Permanent Address


Country and City Code

Country and City Code










Please note: to visit the US for medical care, you may need to obtain a nonimmigrant visa (B-2). Documented proof of sufficient funds may be required to cover all costs related to your travel, in addition to hospital and physician fees. Please visit Visitor Visa (state.gov) for detailed visa requirements.

Additional Details
Preferred Travel Dates
                                                                                       
Preferred Travel Start Date
Preferred Travel End Date