Cancer Clinical Trials Contact Form

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Requester (non-patient) Information

If you aren't the patient, please answer the questions below and then complete the patient information for the patient. If you are the patient, please skip this section and complete only the patient information section.

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Patient Information

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Identifying your race and ethnicity assures that everyone gets appropriate access to the health care they need. The information you report is voluntary and confidential.

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Important: After submission, please do not leave this form until you see the confirmation message.

Mayo Clinic Number

Your Mayo Clinic number is a 7, 8 or 9-digit number we assign to you as a new patient prior to your first visit. You can find it near the top of a range of documents, including pre-visit questionnaires, clinical notes, care summaries, and correspondence.

If you do have Mayo paperwork handy, it's often quickest simply to look for it there. Scroll down to see some examples of how the number shows up:

In correspondence:

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Cancer Studies Contact Form

Mayo Clinic Number

In correspondence:

In pre-appointment questionnaires

In medical documents:

In dismissal summaries:

In several other kinds of documents:

Mayo Clinic Number

In correspondence:

In pre-appointment questionnaires

In medical documents:

In dismissal summaries:

In several other kinds of documents:

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