Request a Specialist Review

Please briefly describe the patient’s current medical concern and upload any available medical reports, test results, or imaging records. Based on the information provided, an MGH advisor will follow up with you regarding possible next steps, including written second opinion, video consultation, or additional materials needed for specialist review.

Please Note: This form is intended for non-emergency appointment requests from international patients. If you are experiencing a medical emergency, please contact your local emergency services or go to the nearest emergency department immediately.

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Your Name *

First

Last

concerns Region selected

Email Address *

Phone Number *

Country / Region of Residence *

Please enter where you are currently located, such as London, UK; Toronto, Canada; or Shanghai, China.

Passport Issuing Country / Region *

Who are you inquiring for? *— Select —SelfFamily / CaregiversFriendOther

If you selected Other, please specify.

Health Information

Gender *— Select —MaleFemaleOtherPrefer not to say

Please enter the patient’s gender.

If you selected Other, please specify.

Date of Birth *

Please enter the patient’s age.

What health concerns are you currently experiencing? *

Please briefly describe the patient’s current health condition, symptoms, diagnosis, or medical concern. You may include when the problem started, how it has changed over time, and whether it is affecting daily activities.

How long has the patient had these symptoms?

For example: 2 weeks, 6 months, several years, since an injury, since a previous surgery, or recently getting worse.

Has the patient already received a diagnosis from a doctor? *— Select —YesNoNot sure

If yes, please provide detailed information.

Does the patient already have X-ray, MRI, CT, or other imaging records? *— Select —YesNoNot sure

Please upload medical reports or related records

Drag & Drop Files, Choose Files to Upload You can upload up to 15 files.

If available, please upload X-rays, MRI, CT scans, medical reports, doctor’s diagnosis, surgery recommendations, or previous surgery records.

Service Preferences

What is your preferred contact method? *

• Email
• Phone
• WhatsApp

How would you like to receive your second opinion? *

• Written Second Opinion
• Video Consultation
• Not Sure Yet

What would you like a second opinion on? *

Please briefly describe what you would like the specialist to review or clarify, such as the diagnosis, recommended treatment plan, need for surgery, possible alternatives, ongoing symptoms, or concerns after a previous treatment.

Additional notes

Please add any other information you would like us to know.

Privacy Policy *

• I have read and agree to the Privacy Policy, and I understand that this form is for initial inquiry only. *

Verification Code *

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