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Referral Information Forms

Referral/Consultation Request Form

To ensure continuity of care for the patient and to clarify if the request is for an opinion or transfer of care, please use the Referral /Consultation Request Form and fax to the appropriate department when scheduling an appointment.

Cardiac CTA Referral Form

To refer a patient for a cardiac CTA, use the CCTA Physician Referral Forms below.

Referral Form for PET/CT

To refer a patient for a PET/CT scan, use the Referring Physician PET/CT - Ordering Form.

Referral Form for Pain Management

To refer a patient for Pain Management use this form . Include a letter of referral with the patient.

PICU Consultation and Transport Criteria

If your patient meets the PICU consultation and transport criteria, refer directly to Sanford Children's PICU by calling (800) 437-4010 and asking for the pediatric intensivist on call.

NICU Consultation and Transport

Neonatal emergency medical information. If you need to consult with or refer to Sanford Children's NICU call (800) 443-4779 (Press #1).