Referral Process and Forms

Medically urgent referrals

  • Submit directly to our MD Portal at mdportal.stanfordchildrens.org
  • If you are unable to submit directly to MD Portal, please fax to (650) 721-2884 

All other outpatient referrals

Please provide the following for outpatient referrals:

  1. Stanford Medicine Children’s Health Referral Request Form or the form is also available on the MD Portal
  2. Relevant notes
  3. Copy of patient’s insurance card
  4. Authorization for Treatment (if required by insurance provider)

Fax all forms to (650) 721-2884 or submit electronically via mdportal.stanfordchildrens.org

Outpatient specialty referrals

The following services require specific referral forms and/or clinical notes: