Referrals During COVID-19

In response to the COVID-19 pandemic, The Polyclinic is limiting in-person visits to patients who require essential services and care. We are committed to collaborating with you for the care of your patients. To help us in scheduling, please indicate if the referral is:

  • Urgent
  • Time sensitive but not urgent
  • Able to be deferred but would like guidance from a provider

We will be providing video visits for our patients, starting with our established patients but soon available for new patients. This will allow us another way to care for your patients. We appreciate your referrals and look forward to working together in the care of your patients.

With more than 35 specialties at The Polyclinic, we want to ensure you have the resources needed to refer your patient for care.

Refer a Patient

1. Determine specialty or service for referral. Visit our clinic directory. Contact sheets available for viewing and printing below (updated quarterly).

2. Send the patient's chart notes and complete documentation directly to the clinic by phone or fax. If urgent, please call the clinic.

  • By Phone – Call the specialty clinic directly. For emergencies, call 911.
  • By Fax – Send complete referral to the specialty clinic directly. Please print clearly and include all demographic and clinical information needed, including insurance, and test or lab reports.

What is considered a complete referral?
Please include all clinical record information, including test or lab reports, patient demographic information, insurance information and reason for referral. Use our referral request or include all information in the faxed referral.

3. What to expect next – Appointments can be scheduled once the referral is processed. Please instruct your patient to call and make an appointment. We will contact you if there is any missing information from the referral.

Referral and Procedure Forms

For most referrals, you can call and fax directly to the specialty clinic office. Below are forms that could be needed depending on the referral.

Stay Connected

For questions regarding the status of a patient referral, please contact the clinic directly. For general questions, email

Colleagues Connect

This quarterly publication provides updates for medical professionals about services at The Polyclinic. Read past issues below:



If you are a medical professional and would like to receive Colleagues Connect, please email our referral specialist.

Quick Links

Physician Care Alliance

Physician Care Alliance (PCA) is a clinically integrated network created through collaboration between The Polyclinic, Physicians Insurance, and Premera Blue Cross. PCA leverages expertise developed by The Polyclinic’s established and successful Physicians Care Network, a separate corporate entity, which has been in existence for nearly 20 years, managing risk through Medicare Advantage products. While clinically integrated networks have gained popularity in recent years, The Polyclinic’s early and enduring success with its initial network is pivotal for PCA. Physician leadership is the core of PCA.

Learn more about the Physician Care Alliance: