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.
You can submit your referral directly to our specialists by either completing the online referral form or printing and completing the referral form. Please access contact information by department or download a quick reference document including contact information for departments not listed on the referral form as their processes may be different.
Referral Form Processing Requirements
Please complete all pages of the referral form. 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.
Frequently Asked Questions About Referrals
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.
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.
Please complete a referral form for each specialty you are referring to, as the information needed to appropriately triage this patient differs by specialty.
So we can obtain all pertinent information prior to the child’s scheduled visit with us.
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.
Please provide legible and relevant information about the child.