Refer a Patient

Please fill out the form below to refer your patient with ease and efficiency. We will reach out within one business day or less. If you would prefer to contact us directly or if this is urgent, you can email us at referapatient@mskcc.org. You call also call our dedicated physician access number at 646-677-7440, which is available Monday to Friday between and (Eastern Time).

Indicates required field

Referring Physician Information

Phone number must be entered using the XXX-XXX-XXXX format.
Phone number must be entered using the XXX-XXX-XXXX format.
What’s your relationship to the patient?

Contact Preferences

Please let us know whom we should contact to indicate that an appointment has been set up.
We will keep you informed as we connect with your patient. What is the best way to reach you?

APP/RN’s Contact Information

Phone number must be entered using the XXX-XXX-XXXX format.
Phone number must be entered using the XXX-XXX-XXXX format.

Patient’s Contact Information

Phone number must be entered using the XXX-XXX-XXXX format.
Please let us know whom we should contact to schedule the appointment.

Caregiver’s Contact Information

Phone number must be entered using the XXX-XXX-XXXX format.

Enter Patient's Medical Information

What type of cancer is suspected or has been diagnosed?

Patient Appointment Information

Are you referring for treatment or referring for a second opinion?
Please schedule my patient with:
We aim to match patients to physicians with relevant expertise in a timely fashion. Specific requests may entail longer waits.
Are you referring this patient for consideration of clinical trials?