Patient Information
 
 
 
 
Are you a Mayo Clinic Patient?*
 
 
 
 
Mayo Clinic Number*
 
 
 
 
First Name*
 
 
Last Name*
 
 
 
Birthdate (mm/dd/yyyy)*
 
 
 
Preferred Contact Method*
 
 
 
 
Phone Number*
 
 
 
 
Email Address*
 
 
 
 
Requesting on behalf of a patient
 
 
 
Requester Name
 
 
Relationship to Patient
 
 
 
Requester Email
 
 
Requester Phone Number
 
 
 
I would like additional information on:
 
Lodging
 
 
 
 
Please provide lodging information:
 
 
Extended Stay Lodging
 
 
 
 
Non-Profit Lodging
 
 
 
 
Campground/RV Parks
 
 
 
 
Hotels/Motels
 
 
 
Please provide desired hotel information:
 
 
Price Range
 
 
 
Please provide price range information:
 
 
$60-$80/night
 
 
 
 
$75-$110/night
 
 
 
 
$100-$130/night
 
 
 
 
$150+/night
 
 
 
 
 
 
Amenities
 
 
 
Please provide desired amenities:
 
 
Complimentary Parking
 
 
 
 
Complimentary Breakfast
 
 
 
 
Complimentary Clinic Shuttle
 
 
 
 
Hot Tub/Indoor Pool
 
 
 
 
Fitness Equipment
 
 
 
 
Kitchenette
 
 
 
 
Pet Friendly
 
 
 
 
Handicap Room
 
 
 
Please provide desired handicap room features:
 
 
Roll in Shower
 
 
 
 
Grab Bars
 
 
 
 
Requires Handicap Transportation
 
 
 
 
Additional Amenities
 
 
 
 
 
Length of Stay
 
 
 
Please choose desired length of stay:
 
 
1-6 days
 
 
 
 
7-14 days
 
 
 
 
15-30 days
 
 
 
 
1-3 months
 
 
 
 
3-6 months
 
 
 
 
6-12 months
 
 
 
 
1+years
 
 
 
 
 
 
Additional Lodging Questions
 
 
 
 
Transportation
 
 
 
 
 
 
 
Minneapolis Airport
 
 
 
 
 
 
Limo/Sedan - MSP
 
 
 
 
Shuttle Service - MSP
 
 
 
 
Car Rental - MSP
 
 
 
 
 
 
Rochester Airport
 
 
 
 
 
 
Limo/Sedan - RST
 
 
 
 
Shuttle - RST
 
 
 
 
Car Rental - RST
 
 
 
 
Taxi - RST
 
 
 
 
 
 
Winona Amtrak
 
 
 
 
 
 
Shuttle - Winona
 
 
 
 
Limo/Sedan - Winona
 
 
 
 
 
 
Additional Transportation
 
 
 
 
Community Resources
 
 
 
 
 
Private Nursing Services
 
 
 
 
Spa/Salon
 
 
 
 
Daycare
 
 
 
 
Pet Boarding
 
 
 
 
Additional Community Resources
 
 
Recreation/Entertainment
 
 
 
 
 
Tours
 
 
 
 
Hiking/Biking
 
 
 
 
Children’s Activities
 
 
 
 
Theatre/Arts
 
 
 
 
Shopping
 
 
 
 
Additional Recreation/Entertainment
 
 
 
 
Dining
 
 
 
 
 
Dining interests
 
 
 
 
Mayo Clinic
 
 
 
 
 
Wheelchair/Scooter Rental
 
 
 
 
Parking
 
 
 
 
Clinic Tours
 
 
 
 
Rejuvenate Spa
 
 
 
 
Healthy Living Program
 
 
 
 
Sports Medicine
 
 
 
 
Things to Do at Mayo Clinic
 
 
 
 
Additional Mayo Clinic
 
 
Section title
 
 
Request a packet of information on Rochester and Mayo Clinic
 
 
 
DISCLAIMER: If you are requesting a packet within two weeks of your upcoming appointment, please know that your packet may not reach you in time. If you do not receive your packet, please stop by our Concierge Services desk and we would be happy to provide you one. Also note that your packet will not include an appointment schedule or information about upcoming appointments.
 
 
 
Requesting Person Address*
 
 
Requesting Person City*
 
 
Requesting Person State/province*
 
 
Requesting Person Postal Code*
 
 
How may we assist you?