Make an Appointment

Call us directly to make an appointment with the Pancreas Transplant Program.

877-644-2860

Whether you require a kidney/pancreas or a pancreas transplant alone, your first appointment will be a comprehensive evaluation. You must submit the below secure form to schedule your pre-transplant evaluation. Learn more about our Transplant Evaluation Program.

icon showing high importanceTo ensure a smooth and expedited intake process: 

Please call Mass General registration at 866-211-6588, Monday-Friday, 8:00 am to 5:00 pm ET.

Please submit the secure form below to refer your patient to a provider in the Pancreas Transplant Program at Massachusetts General Hospital. Please be sure to request that your endocrinologist or primary care provider submit the following required documents via fax: 617-726-0822.

  • Recent endocrinologist visit note with last hemoglobin A1c and c-peptide titer
  • 2728 CMS ESRD form (if on chronic dialysis)
  • Recent nephrologist visit note, if applicable
  • Recent ED discharge summary
  • Pertinent test results (e.g., abdominal/pelvic CT scan)
  • Insurance information
Please use this form only if:
  • You have never been a patient in the Pancreas Transplant Program, OR
  • You have been a patient in the Pancreas Transplant Program but are seeking an appointment with a new clinical area or doctor

Please call 911 if you are experiencing a medical emergency.

Requestor Information










If you are an international patient, please complete the International Patient Appointment Form.

Patient Information








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The 2728 form must be included in the referral submission.


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Referring Physician