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How to Refer a Patient

How to Request an Outpatient Clinic Appointment

Referral Form
 
 
Need Help? Uncertain Who to Call?
 
(608) 263-8013
Information for Referring Physicians and Other Providers
 
UW Hospital and Clinics in Madison, Wisconsin, and the American Family Children's Hospital offer services at 80 different specialty clinics. In order to assist you with referring a patient, we have streamlined the referral process by creating one form and one fax number for you to use to request an appointment.
 
If you currently call a UW Health clinic directly to arrange referrals, feel free to continue to do so if that is your preference. You can also use the fax system described below if it is more convenient.
 
Many clinics will schedule the appointment within one to two days of receiving your appointment request; however some clinics may require additional triage time.
 
For all other services, including radiology, lab and procedures, please continue to call the appropriate department.
 
How the Referral Process Works
 
When you need to refer a patient to UW Hospital and Clinics or American Family Children's Hospital, please:

Please do the following:

  • Complete the entire form 
  • Include the referring provider's signature
  • Fax a copy of the patient's insurance card
  • Fax a copy of any pertinent clinical information, including lab and radiology results
  • Inform the patient that we will contact him/her to schedule the appointment

NOTE: Urgent and Outreach Referrals

  • For urgent referrals, please call the appropriate UW Health specialty clinic
  • To schedule an appointment in an outreach clinic, please call that clinic directly

Once the form is received, it will be reviewed and processed. You will receive one of the following:

  • Appointment Status Form – UW Hospital and Clinics/American Family Children's Hospital will contact the patient to arrange the appointment. A fax will be sent to you to notify you of the status of the appointment.
  • Request for Additional Information Form – There may be times when additional information is needed in order to schedule an appointment. A fax will be sent to you to request this information.

Need Help? Uncertain Who to Call?

 

Call Provider Relations at (608) 263-8013. Thank you for your assistance.