Virginia Commonwealth University

VCU Massey Cancer Center

Menu

Request an appointment / Refer a patient

This form is for patients to use in requesting an appointment and for physicians to use to refer a patient.

If you would prefer to speak with a patient services representative at VCU Massey Cancer Center or one of our referral coordinators about an appointment, please call (804) 828-5116, or toll-free (877) 4-MASSEY [(877) 462-7739], Monday through Friday, from 8 a.m. until 4:30 p.m.

To help us help you, please fill in all relevant fields. When you are finished, please click the “Submit” button at the bottom of the form to send your request. We will contact you within one business day of receipt.

Required fields*

Information about person sending this form

Information about the patient

Gender

Information about the referring physician (if applicable)

Information about patient's primary care physician