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Online Physician Referral Form

A talented staff of physicians, nurses, therapists, technologists, and other health care professionals bring expertise to every aspect of patient care at the University of Illinois Hospital & Health Sciences System. Our goal is to make your referrals to UI Hospital as easy as possible for you and your patient. UI Health System has been moving medicine forward for the benefit of the people of Illinois and beyond since 1859. The UI Health System includes a 495-bed tertiary hospital, an outpatient facility, specialty clinics, the College of Medicine, and six other health science colleges. More new physicians earn their medical degrees here than at any other medical school in the country. As a leader in patient care, research and education, UI Health System is committed to changing medicine and changing it for good.

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First Name Last Name Date of Birth Primary Phone Alternate Phone Best time to contact Diagnosis Specialty Requested

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