Lung Center New Patient Appointment Requests

By using this form you may refer yourself to our clinic. Your information will be sent securely via email to one of our New Patient Coordinators. You will be contacted shortly to set up a time for the appointment and to give you additional information. If you prefer, you may call our Patient Coordinators directly at 1-844-BWH-LUNG (1-844-294-5864) Monday through Friday, 7:30am - 5:00pm.

Please include reason for appointment in the Additional Information field below. For example, Lung Cancer Screening, nodule scan.

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Patient's Full Name: *Street Address: *Street Address Line 2:City *State/Province: *ZIP/Postal Code:Country *Daytime Phone: *Evening Phone:Email Address: *Select a Thoracic Surgeon:Select a Pulmonary and Critical Care Physicians:Additional Comments:

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Lung Center New Patient Appointment Requests

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