How to Make a Referral

Requesting a referral by phone

Call the DHMC Physician Connection Center (health care professionals only), Monday through Friday, 8:00 am to 5:00 pm.

Please have the following patient information available in order to quickly expedite your referral request:

  • Full name (including maiden name, if known)
  • Date of birth, social security number, or DHMC medical record number
  • Current address
  • Current phone number
  • Current insurance information
  • Special needs requirements (interpreter, transportation, preferred day of week for appointment, etc.)
  • Medical history (associated medical conditions, current and ongoing treatments, X-rays, allergies, medications, etc.)
  • Presenting symptoms/diagnosis and duration
  • Physical findings

Faxing a referral request

If you prefer to fax your request, complete one of the following forms:

Fax your request and all pertinent patient notes to the Physician Connection Center.

Note: To download electronic versions of these forms, please select the correct form, when available, from the Adult Referral Forms or the Pediatric Referral Forms page.

What happens once I have placed my referral?

Once your request is received, it is logged into our tracking system. A Connection Center representative acts on your behalf to facilitate your request, contacting the appropriate section(s) and following the request through to completion. Your office is notified of the patient's appointment date, time, and location once it is scheduled. Depending upon the urgency of your request and the need to communicate with the patient for scheduling purposes, response times may vary.