Refer a Patient | University of Utah Health

Thank you for contacting Dermatology Services at University of Utah Health. We value our relationship with referring physicians.

To refer a patient, please fill out your patient's personal information below and click on the button labeled "Submit".

Referring provider name*:

Referring office phone number*:

Referring office fax number:

Name*:

Date of Birth*:

Sex*:

Male Female Other

Phone*:

Address*:

City*:

State*:

Zip*:

Type of consult*:

Reason for referral *:

Or Call 801-581-2955