How to Request a Remote
Second Opinion

1. To initiate the application process, please contact the Remote Second Opinion Program Coordinator, Ms. Jana Goins at 410.502.6160.
2. Complete and return the following forms:
   a) Payment Authorization
   b) Consultation Request
   c) Patient Disclaimer
   d) Patient Medical History
   e) Patient Intake
3. Please send all applicable medical records and reports (see Forms and Documentation)

All medical information (reports, results, MRIs etc) and application materials should be mailed via Fed-Ex to:

Ms. Jana Goins
Johns Hopkins 2nd Opinion Program
The Johns Hopkins Hospital
Pathology Building, Room 627
600 N. Wolfe Street
Baltimore, MD
21287-6965

Tel:    410.502.6160
Fax:   410.502.3665
Email:   jgoins3@jhmi.edu

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• Required Forms & Documentation
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