Massey appointment worksheet
Whether you are coming for your first appointment, for scheduled treatment or for follow-up care, our patient care coordinators are here to assist you. Please print and use this worksheet when scheduling your next visit.
Please call (804) 828-5116, Monday through Friday from 8 a.m. until 4:30 p.m. If you are calling from outside the Richmond area, please phone toll free (877) 4-Massey.
Information to have ready when making an appointment
If you are a new patient, please plan to have the following information ready so we may serve you more quickly and efficiently:
- Full legal name of patient (including middle name and generational suffix, such as “Jr.” or “III”)
- Home address (including city, state, ZIP and country)
- Home phone number
- Work phone number
- Mobile (cell) phone number
- Emergency contact number
- E-mail address
- Date of birth
- Gender
- Health insurance plan
- Health insurance type
- Referring physician (if applicable) or your primary care physician
- The physician’s phone number
- Reason for appointment (type of cancer or problem you have)
Record your appointment information below
Name of cancer specialist or team:
__________________________________________
Date and time of appointment:
__________________________________________
Location of appointment (facility):
__________________________________________
(Location within facility):
__________________________________________
Special instructions (if any):
__________________________________________
