Skip to content
My Health Connection
Billing & pricing
Referrals
Select Language
Afrikaans
Shqip
አማርኛ
العربية
Հայերեն
Azərbaycan dili
Euskara
Беларуская мова
বাংলা
Bosanski
Български
Català
Cebuano
Chichewa
简体中文
繁體中文
Corsu
Hrvatski
Čeština
Dansk
Nederlands
English
Esperanto
Eesti
Filipino
Suomi
Français
Frysk
Galego
ქართული
Deutsch
Ελληνικά
ગુજરાતી
Kreyol ayisyen
Harshen Hausa
Ōlelo Hawaiʻi
עִבְרִית
हिन्दी
Hmong
Magyar
Íslenska
Igbo
Bahasa Indonesia
Gaelige
Italiano
日本語
Basa Jawa
ಕನ್ನಡ
Қазақ тілі
ភាសាខ្មែរ
한국어
كوردی
Кыргызча
ພາສາລາວ
Latin
Latviešu valoda
Lietuvių kalba
Lëtzebuergesch
Македонски јазик
Malagasy
Bahasa Melayu
മലയാളം
Maltese
Te Reo Māori
मराठी
Монгол
ဗမာစာ
नेपाली
Norsk bokmål
پښتو
فارسی
Polski
Português
ਪੰਜਾਬੀ
Română
Русский
Samoan
Gàidhlig
Српски језик
Sesotho
Shona
سنڌي
සිංහල
Slovenčina
Slovenščina
Afsoomaali
Español
Basa Sunda
Kiswahili
Svenska
Тоҷикӣ
தமிழ்
తెలుగు
ไทย
Türkçe
Українська
اردو
O‘zbekcha
Tiếng Việt
Cymraeg
isiXhosa
יידיש
Yorùbá
Zulu
Help me find
Search
UCHealth
Doctors
Specialties
Locations
Schedule Appointment
Virtual Urgent Care
COVID-19 Testing
Menu
Doctors
Specialties
Locations
Schedule Appointment
Virtual Urgent Care
COVID-19 Testing
About UCHealth
Careers
Classes & events
Employees
Clinical trials
For Media
Open & safe
Professionals
News & stories
Contact us
My Health Connection
Billing & pricing
Referrals
Select Language
Afrikaans
Shqip
አማርኛ
العربية
Հայերեն
Azərbaycan dili
Euskara
Беларуская мова
বাংলা
Bosanski
Български
Català
Cebuano
Chichewa
简体中文
繁體中文
Corsu
Hrvatski
Čeština
Dansk
Nederlands
English
Esperanto
Eesti
Filipino
Suomi
Français
Frysk
Galego
ქართული
Deutsch
Ελληνικά
ગુજરાતી
Kreyol ayisyen
Harshen Hausa
Ōlelo Hawaiʻi
עִבְרִית
हिन्दी
Hmong
Magyar
Íslenska
Igbo
Bahasa Indonesia
Gaelige
Italiano
日本語
Basa Jawa
ಕನ್ನಡ
Қазақ тілі
ភាសាខ្មែរ
한국어
كوردی
Кыргызча
ພາສາລາວ
Latin
Latviešu valoda
Lietuvių kalba
Lëtzebuergesch
Македонски јазик
Malagasy
Bahasa Melayu
മലയാളം
Maltese
Te Reo Māori
मराठी
Монгол
ဗမာစာ
नेपाली
Norsk bokmål
پښتو
فارسی
Polski
Português
ਪੰਜਾਬੀ
Română
Русский
Samoan
Gàidhlig
Српски језик
Sesotho
Shona
سنڌي
සිංහල
Slovenčina
Slovenščina
Afsoomaali
Español
Basa Sunda
Kiswahili
Svenska
Тоҷикӣ
தமிழ்
తెలుగు
ไทย
Türkçe
Українська
اردو
O‘zbekcha
Tiếng Việt
Cymraeg
isiXhosa
יידיש
Yorùbá
Zulu
Help me find…
Search
Search
Doctors
Specialties
Locations
Inspiring stories delivered to your inbox
Subscribe to
UCHealth Today
.
The latest
COVID-19 information for community providers
Yesterday
COVID-19 information
Yesterday
Are you feeling exhausted, anxious or sad? 5 tips for handling ‘pandemic fatigue.’
Yesterday
UCHealth launches second COVID-19 vaccine trial
October 29th, 2020
Help me find…
Search
Search
×
Refer your patient now
Patient’s information
First Name
*
Last Name
*
Name
First
Last
DOB
*
MM
DD
YYYY
Sex (Legal)
*
Choose from drop down
Female
Male
Other
Gender Identity
Choose from drop down
Female
Male
Transgender Female / Male-to-Female
Transgender Male / Female-to-Male
Other
Choose not to disclose
Phone number
*
Insurance
*
Referring provider information
First Name
*
Last Name
*
Name
*
First
Last
Specialty
*
Location
*
Phone number
*
Fax number
*
Referral
(No radiology orders, please)
Department/specialty referred to
*
Preferred location of consultation
*
Diagnosis
*
Priority
*
Choose from drop down
Routine
ASAP
Urgent
Priority
*
Routine
ASAP
Urgent
Please send any pertinent, clinic records related to the DX to prl@uchealth.org
Name
This field is for validation purposes and should be left unchanged.
×
If you are experiencing an emergency
please call
911
immediately.
We use cookies to make interactions with our website easy and meaningful. By continuing to use this site you are giving us your consent.
Learn how cookies are used on our site.
Accept terms