Now Taking Physician Referrals Learn more about patient safety precautions, virtual visit options, and referring physician resources. 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. Adolescent Medicine General Fax: 801-587-7539 Prescription Refills Fax: 801-213-7600 Cardiology General Fax: 801-587-7539 Prescription Refills Fax: 801-213-7600 Complex Care General Fax: 801-587-7539 Prescription Refills Fax: 801-213-7600 Endocrinology General Fax: 801-587-7539 Prescription Refills Fax: 801-213-7600 GI General Fax: 801-587-7539 Prescription Refills Fax: 801-213-7600 Genetics General Fax: 801-587-7539 Prescription Refills Fax: 801-213-7600 Nephrology General Fax: 801-587-7539 Prescription Refills Fax: 801-213-7600 PM&R Phone: 801-662-5888 General Fax: 801-587-7539 Prescription Refills Fax: 801-213-7600 Pulmonary/Sleep Medicine General Fax: 801-587-7539 Prescription Refills Fax: 801-213-7600 Rheumatology General Fax: 801-587-7539 Prescription Refills Fax: 801-213-7600 Referring Provider Name: * Referring Office Phone Number: * Referring Provider Email: * Referring Office Fax Number: Referring Provider Npi Number: * Type Of Consult: * Preliminary Diagnosis: * Reason For Referral: * Patient Information Name: * Date Of Birth: * Phone: * basic info Street: * City: * State: * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP: * Leave this field blank