Refer a Patient to Pediatric Services

Call  801-213-3599

Consultation & Referral Services

Pediatrics is here to assist community physicians and specialists with consultation and referral services. To refer a patient, please complete the form below and fax all related clinic notes and diagnostic reports to the specialty fax number.

If no fax or online referral form is listed, you will need to call the service directly.
 

Contact & Fax Information

General Fax: 801-587-7539
Prescription Refills Fax: 801-213-7600

  • Adolescent Medicine
  • Cardiology
  • Complex Care Endocrinology
  • GI/Gastroenterology
  • Genetics
  • Nephrology
  • Pulmonary/Sleep Medicine
  • Rheumatology

Specific Specialty Contact Information

PM&R (Physical Medicine & Rehabilitation)

Cardiology Referral Information
Reason for Cardiology Referral
If testing only, please check the tests that apply:

Patient Symptoms

If your patient has non-exertional postural dizziness consistent with postural orthostatic tachycardia syndrome (POTS) or symptoms of dysautonia, please call the PAUSE clinic at 801-662-1360.

Signs of Heart Disease
Medical History
Family History of Heart Disease

Additional Clinical History

Prior tests performed: Please select all that apply.

Please fax all records related to the tests selected above to 801-587-7539. Include a demographic sheet and cover sheet indicating that the records are associated with a referral.

Urgency Rating

*In addition to submitting this referral form, please call our cardiology provider at 844-662-1662 to discuss.

Patient Information