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.stanfordchildrens.org

Outpatient Specialty Referrals

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

General Out-patient Referral Form

Audiology

Center for Fetal and Maternal Health

Developmental-Behavioral Pediatrics, Please include growth chart

- ECG, Echo, Holter Monitor or Event Recorder

- EEG - Outpatient

- Endocrinology, Please include pertinent labs, growth chart and notes from last 3 visits.

- Exercise Laboratory

Fetal Echocardiogram

- Genetics, Please include growth chart.

- Hematology, Please make direct referral by calling (650) 497-8953.

- Infectious Disease, Please include immunization records.

- Motion & Gait

- Nephrology,  Please include pertinent labs.

- Neurology

- Neuro-Oncology, Please make direct referral by calling (650) 497-8953.

- NeurosurgeryPlease include pertinent labs, MRIs and/or CTs

- Nuclear Medicine

- Oncology Please make direct referral by calling (650) 497-8953.

Pain Management

Perinatal Diagnostic Center (PDC)

Pulmonary Clinic

Radiology

Rehabilitation Services

Sleep Clinic

- Urology, Please include pertinent labs and radiology reports

Weight Clinic/ Weight Control Program, Please include growth chart

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

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