Refer a Patient | University of Utah Health

The Cardiovascular Center is here to assist community physicians and specialists with consultation and referral services. To request an appointment online, please fill out the information below and click on "Submit". You will receive a response within one business day.

Please be aware, we can only respond to your request during normal business hours, 8 am–5 pm, Mon–Fri.

Referring Provider Name*:

Referring Office Phone Number:

Referring Office Fax Number:

Patient's Name*:

Patient's Date of Birth (MM/DD/YYYY)*:

Patient's Gender*:

*If you selected 'Other' for patient gender please specify how the patient identifies:

Patient's Phone*:

Patient's Address*:

City*:

State*:

Type of Consult*:

Preliminary Diagnosis*:

Reason for Referral*:

Request a Specific Provider:

Urgency Rating:

Or Call 801-585-7676

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