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Our goal is to make your referral to UI Health as easy as possible for you and your patient.

Please complete the below form to help us ensure a safe, efficient for your patient. 

Thank you for referring patients to UI Health!

We value our relationship with you, your patients, and your practice team. We are committed to keeping you informed of your patients' care by providing timely and comprehensive follow-up, from diagnosis to treatment. Our goal is to provide you with prompt service and excellent communication regarding your patients. Thank you for partnering with us on your patients' care.

Patient Information


Does patient have insurance? *

Insurance information is required so we can best match a doctor and their accepted insurance plans

Yes Not Sure / No Insurance