Refer a Patient for an Outpatient Specialty Clinic Appointment
UW Health offers services at more than 80 specialty clinics. If you are a physician or health care professional looking to refer a patient for outpatient care, please use one of the following options.
This form can be used when referring a patient to any of the UW Health pediatric or adult specialty clinics.
FAX: Complete the Request for Clinic Appointment Form (pdf)
PHONE: To find a number, options include:
How the "Request for Clinic Appointment Form" Referral Process Works
- Complete the Request for Clinic Appointment Form
- Fax it to (608) 203-2661 or toll-free at (888) 875-8490
- Complete the entire form.
- Fax a copy of any pertinent clinical information, including lab and radiology results, to (608) 203-2661 or (888) 875-8490.
- Inform the patient that we will contact him/her to schedule the appointment.
- An Appointment Status form. UW Health will contact the patient to arrange the appointment. A fax will be sent to you to notify you of the status of the appointment.
- A Request for Additional Information form. If additional information is needed in order to schedule an appointment, a fax will be sent to you to request this information.
- A phone call to request additional information or to communicate appointment information.