Referral Process and Forms

Medically Urgent Referrals

Call the Referral Center directly at (800) 995-5724.
Requested information should then be faxed to (650) 721-2884.

All Other Outpatient Referrals

Please provide the following for outpatient referrals:

  1. Stanford Children’s Health Referral Request Form (Download form or on MD Portal )
  2. Relevant notes
  3. Copy of patient’s insurance card
  4. Authorization for Treatment (if required by insurance provider)

Fax all forms to (650) 721-2884 or submit electronically via mdportal.lpch.org

Outpatient Specialty Referrals

The following services require specific referral forms and/or clinical notes:

For information about services not listed, call the Stanford Children’s Health Physician Referral Center

Monday – Friday
7:00am – 6:00pm
(800) 995-5724