Faxing a referral request
Please note: We do not take referrals by phone.
- Fax your referral form to the appropriate fax number. The fax number to use will be indicated on the referral form.
Please DO NOT fax to the department's office fax number. - If you're using your own outpatient referral form, please ensure it contains the following information:
- Full name (including maiden name, if known)
- Date of birth, social security number, or medical record number
- Current address
- Current phone number
- Current insurance information
- Special needs requirements (interpreter, transportation, preferred day of week for appointment, etc.)
- Medical history (associated medical conditions, current and ongoing treatments, X-rays, allergies, medications, etc.)
- Presenting symptoms/diagnosis and duration
- Physical findings
What happens once I have placed my referral?
Once your request is received, it is logged into our tracking system. A connection center representative will help you with your request, contacting the appropriate sections, and following the request through to completion.
Once an appointment is scheduled, your office is notified of the patient's appointment date, time, and location.
Please note: Response times may vary depending on the urgency of your request and the need to communicate with the patient for scheduling purposes.