Specialty Visit Referral Process

Before making a referral for services at Connecticut Children’s Medical Center, please review the referral guidelines for the specialty to which you are referring.

All Urgent and All Surgical Referrals

To refer for urgent care, or to any surgical department, please call the specialty department directly. Please refer to our quick reference for referrals for the appropriate contact information.

Non-Urgent, Medical Subspecialty Referrals

Referring providers are able to make non-urgent referrals to Connecticut Children’s medical subspecialists by completing an online referral form.

All pages of the referral form must be completed. Demographic information may be transcribed to the referral form or provided in an uploaded copy of the demographic sheet from your computer system.

Please review the list of information needed when making specialty referrals.

If you prefer to fax your referral, click here for a downloadable PDF form.


Quick Reference for Referrals and Admissions
Send Feedback

Referral FAQ

Why should I use this referral form?

To best meet you and your patient's needs, this form ensures that your referral is being processed efficiently and that we understand the patient's medical condition and history.

If I have an older version of this form, is it appropriate to use?

Please use the most up-to-date version of the form. We ask that you refer to this website regularly for updates, since we will update materials based on feedback from our referring providers.

If I am referring the same patient to more than one specialist, can I send one referral form?

Please complete a referral form for each specialty you are referring to, as the information needed to appropriately triage this patient differs by specialty.

Why do you need to know about other specialists that our patient has seen?

So we can obtain all pertinent information prior to the child's scheduled visit with us.

What can I expect from Connecticut Children's?

We will communicate back to you, either to request more information or to provide you with the child's appointment date, time and location. Every effort is made to get back to you within one week of receiving the non-urgent referral form.

What can I do to help this process?

Please provide legible and relevant information about the child.