Refer a Patient

To refer a patient to a UW Medicine physician, please complete the form below. If you prefer, you may complete the PDF version of the form. For questions about referrals, please contact the UW Medicine Contact Center at 206.520.5000 or 1.877.520.5000​ toll free. The Contact Center's hours of operation are Monday - Saturday: 7:00 a.m. to 7:00 p.m. and Sunday: Closed.

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Patient Information
Patient Contact Information
Your Name
Your Contact Information

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