Referrals During COVID-19
The Polyclinic is committed to helping you navigate the care of your patients during COVID-19. Learn more about visit types currently available.
Refer a Patient
We appreciate your referrals and look forward to working together in the care of your patients. With more than 35 specialties, we want to ensure you have the resources needed to refer your patient.
1. Determine specialty or service for referral. Contact sheets available for viewing and printing below (updated quarterly).
- Specialty Physicians and Services - Allergy-Orthopedics
- Specialty Physicians and Services - Otolaryngology-Vascular Surgery
- Pediatricians and Specialists Who Treat Pediatric Patients
- Primary Care Providers with Open Practices
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.
Additional Referral Resources
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.
- Referral Request for All Specialty Clinics
- Diagnostic Imaging Referral Form
- Laboratory Test Requisition Form
- Reverse Sequence Syphilis Screening
For questions regarding the status of a patient referral, please contact the clinic directly. For general questions, email firstname.lastname@example.org.