How to Submit a Mayo Clinic Referral: Fax Form MC0688-04 or CareLink

Providers can submit a Mayo Clinic referral form two ways: through the CareLink online portal at carelink.mayoclinic.org, or by downloading fax form MC0688-04, filling it out on a computer, printing it, and faxing it to the campus where you want the patient seen. You do not need an existing relationship with anyone at Mayo Clinic to refer a patient.1Mayo Clinic. How to Refer Patients to Mayo Clinic

Choosing Between the Fax Form and CareLink

Either method captures roughly the same information. The fax form is faster the first time you refer, because CareLink accounts take a few days to activate: after you request an account, Mayo Clinic sends a courtesy email, then a second email three to four business days later with instructions to complete registration. If your patient needs to be seen soon and you don’t yet have portal access, use the fax form now and set up CareLink for future referrals. Once you’re on the portal, you can upload documents and DICOM images directly and track the referral’s status in real time.2Mayo Clinic. Mayo Clinic CareLink – Referring Patients to Mayo Clinic

Filling Out Fax Form MC0688-04

Download form MC0688-04 from Mayo Clinic’s website and open the PDF on your computer so you can type into the fields before printing.1Mayo Clinic. How to Refer Patients to Mayo Clinic The form has three main sections.

Referring Provider Information

Enter your name, practice name, office address, NPI number, phone, fax, and email.3Mayo Clinic. Referring Physicians Web Fax Form – MC0688-04 This is where Mayo Clinic will send communication about the referral, so make sure the fax and email are ones you actually monitor.

Patient Information

Enter the patient’s legal name, date of birth, sex assigned at birth, address, and phone numbers. Optional fields include the patient’s email, spouse’s first name, maiden name, and Mayo Clinic number if the patient has been seen there before. Indicate whether the patient needs an interpreter, and flag whether the visit relates to a motor vehicle accident, litigation, or workers’ compensation.3Mayo Clinic. Referring Physicians Web Fax Form – MC0688-04

Appointment Request

This is the section that determines whether the referral gets routed correctly. Enter:

Be specific about the clinical question. A narrowly focused referral that names the concrete question tends to move through intake faster than a general request for a comprehensive workup.

Where to Fax the Form

Each campus has its own referral phone and fax lines. Send the form to the campus where you want the patient seen.

  • Phoenix/Scottsdale, Arizona: Phone 866-629-6362 (toll-free) · Fax 480-301-4071
  • Jacksonville, Florida: Phone 800-634-1417 (toll-free) · Fax 904-953-0575
  • Rochester, Minnesota: Phone 800-533-1564 (toll-free) · Fax 800-321-1368

International direct-dial numbers are Phoenix 480-301-6539, Jacksonville 904-953-7000, and Rochester 507-538-1515.4Mayo Clinic. Referrals

Submitting Through CareLink Instead

Once your CareLink account is active, log in at carelink.mayoclinic.org and select the option to make a new referral request. The portal walks you through the same categories the fax form covers:

What Records to Send With the Form

Fuller records mean faster review. Send recent progress notes and the test results most relevant to the clinical question at a minimum. Add pathology reports, lab work, and radiology images when they bear on the diagnosis. CareLink accepts DICOM image uploads directly; fax referrals can be supplemented by mailing physical media.2Mayo Clinic. Mayo Clinic CareLink – Referring Patients to Mayo Clinic A detailed medication list and a summary of previous treatments help the specialty team decide whether the patient might qualify for a clinical trial or advanced procedure. Digitize outside records before uploading, and check that pages fax legibly. Incomplete or unreadable records are one of the easiest ways to stall a referral.

One Thing You Don’t Need to Send

Do not send a separate signed release-of-information form with the referral. Mayo Clinic collects patient authorization directly during the patient’s visit, using its own Authorizations and Service Terms signature form to satisfy federal and state privacy requirements.2Mayo Clinic. Mayo Clinic CareLink – Referring Patients to Mayo Clinic5Mayo Clinic. Patient Checklist

Referring an International Patient

International referrals follow a slightly different intake. Enter the patient’s name exactly as it appears on their passport, plus gender, address, date of birth, direct phone number, and email. Provide a short explanation of the medical problem in English, indicate whether an interpreter is needed, and specify the language.6Mayo Clinic. International Appointment Process

The international appointment team may request additional records after the initial submission. Some assessments require a specialist to review radiology studies or pathology slides before scheduling, which can incur charges before any visit takes place. A team member typically contacts international patients within two business days of receiving the request. Traveling to the United States for care generally requires a visa; Mayo Clinic can explain the visa process and will issue a visa support letter once an appointment date is confirmed, but the clinic does not assist with the visa application itself.6Mayo Clinic. International Appointment Process

What Happens After You Submit

Mayo Clinic’s intake team reviews the records and evaluates whether and how the clinic can help. There is no fixed processing window; the clinic states only that appointment coordinators work to get patients seen as soon as possible.7Mayo Clinic. Common Appointment Questions If you submitted through CareLink, track status in the portal.1Mayo Clinic. How to Refer Patients to Mayo Clinic When the referral is accepted, Mayo Clinic contacts the patient directly to schedule. That contact often includes pre-appointment instructions such as fasting requirements, copies of imaging to bring, or forms to complete in advance. If the first consultation reveals underlying conditions or suggests further testing, additional days of evaluation may be scheduled on-site.8Mayo Clinic. How to Make the Most of Your Mayo Clinic Appointment