Mayo Clinic Complex Care Program Referral (U.S. residents)
Employers, third party administrators (TPAs) or other contracted entities should complete the form below to submit a referral request to Mayo Clinic.
All fields are required unless marked optional.
Patients should not use this form to self-refer to Mayo Clinic. Instead use the patient appointment request form.
There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.
There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.
There is a problem with information submitted for this request. You will need to call to request an appointment.
Appointment Request Confirmation
Thank you for your request. An appointment representative will contact the patient within 2 business days. If you have questions regarding the submitted request please call 507-266-5290.
You indicated that the employer will cover the cost of traveling and lodging for the patient, and the intent to utilize Mayo Clinic Travel Program services. Please email the Mayo Clinic Travel Program team at MAYOCLINICSPECIALTYTRAVELPROGRAM@mayo.edu to begin coordinating travel. If you have questions regarding travel coordination please call 507-266-9488.
Appointment Request Confirmation
Thank you for your request. An appointment representative will contact the patient within 2 business days. If you have questions regarding the submitted request please call 507-266-5290 or email Mayo Clinic at MCCCPI@mayo.edu.