How to Make Referrals

For external referrals (from providers outside of the University of Utah Health System): Please fill out the referral form below here or print out the referral form and fax to 801-585-5723.

For internal referrals (from providers within the University of Utah Health System): Please use EPIC and enter an order for “AMB Referral to Psychiatry” and select Geriatric Psychiatry Clinic.

Health professionals are also welcome to call 801-587-8007 with any patient care inquiries.

Referring Provider Information

Patient Information

Patient Insurance Information

Clinical Information