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 or the form is also available on the 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

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