Referral Process and Forms

MDPortal referrals

• Submit directly to our MDPortal at mdportal.stanfordchildrens.org
• If you are unable to submit directly to MDPortal, please fax to (650) 721-2884 

All other outpatient referrals

Please attach the following for outpatient referrals:

1. Stanford Medicine Children’s Health General Outpatient Referral Request Digital Form or the form is also available on the MDPortal
2. Relevant notes
3. Copy of patient’s insurance card
4. Authorization for Treatment (if required by insurance provider)

Outpatient specialty referrals

We recently launched digital versions of a few forms, to streamline your referral process. We will add many new digital forms over the coming weeks. 

• General Outpatient Referral Request Digital Form
• Sleep Center's Referral Request Digital Form

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

• Audiology referral request form
• Center for Fetal and Maternal Health, referring physician orders
• Developmental-behavioral pediatrics, referral form, Please include growth chart
• Eating Disorders referral form
• ECG, Echo, Holter monitor or event request recorder
• EEG - outpatient referral form
• Endocrinology, Please include pertinent labs, growth chart and notes from last 3 visits.
• Exercise Laborator orders form
• Fetal Echocardiogram orders form
• Genetics referral request form, Please include growth chart.
• Hematology, Please make direct referral by calling (650) 497-8953.
• Infectious Disease, Please include immunization records.
• Motion Analysis and Sports Performance Laboratory referral form
• Motion & Gait referral request form
• Nephrology Please include pertinent labs.
• Neurology referral request form
• Neuro-Oncology, Please make direct referral by calling (650) 497-8953.
• Neurosurgery, Please include pertinent labs, MRIs and/or CTs
• Nuclear Medicine referral request form
• Oncology,  Please make direct referral by calling (650) 497-8953.
• Occupational Therapy Services referral form
• Pain Management referral request form
• Perinatal Diagnostic Center (PDC) referral request form
• Pulmonary Clinic referral request form
• Radiology requisition form
• Speech-Language Pathology Services referral form
• Urology, Please include pertinent labs and radiology reports
• Center for Healthy Weight referral request form, Please include growth chart

Fax all forms to (650) 721-2884 or submit electronically via mdportal.stanfordchildrens.org