Referral Center

The Sanford Health Referral Center connects your patients to the right specialists for their needs. Refer a patient by phone at (844) 851-1515, fax or our online form below.

Records can be faxed to (605) 312-9806.

The Referral Process

1. A physician identifies patient needs.

2. Physician submits referral by phone, fax or online.

3. The referral center finds the appropriate specialist.

4. An electronic referral is sent. The specialty department contacts the patient.

Any information entered on this form is secure and protected according to HIPAA regulations.

Patient Information

Last Name*

First Name*

Middle Initial

Maiden Name / Alternate Name

Gender*

Date of Birth (MM/DD/YYYY)*

Primary Phone Number*

Alternate Phone Number

Address*

City*

State*

ZIP Code*

Insurance Provider*

Reason for Referral

Consultation

Medical Diagnosis*

Provider Signature*

Reason for Request*

Referring Provider Information

Last Name*

First Name*

Middle Initial

NPI

Phone Number*

Fax Number

Address*

City*

State*

ZIP Code*

Country

Email Address*

Patient's Primary Care Provider

Last Name

First Name

Middle Initial

Referral To

Specialty*

Provider Name (if known)

Referral Urgency*

Preferred Location

Our Doctors

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Referral Center

Referral Center

The Referral Process

Patient Information

Reason for Referral

Referring Provider Information

Patient's Primary Care Provider

Referral To

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