Make a Referral

UT Southwestern Patient Referral Program

UT Southwestern: Your Partners in Patient Care

When you send us a referral, we’ll send you regular updates on your patient’s treatment and progress. Our specialists will provide your patient with a multidisciplinary team approach to their care, drawing on the deep well of medical expertise and research available at our academic medical center.

Treating Patients in More Than a Dozen Adult and Pediatric Specialties, Including:

Dermatology
Gastroenterology
General Surgery
Neurology
Ophthalmology
Orthopaedics, Sports Medicine, and Spine
Otolaryngology
Physical Medicine & Rehabilitation
Plastic Surgery
Urology

UT Southwestern physicians provide care in about 80 specialties to more than 105,000 hospitalized patients, nearly 370,000 emergency room cases, and oversee approximately 3 million outpatient visits a year.

Providers who want to make a referral should complete the form below.

All fields required unless indicated.

PATIENT INFO

Patient Name* Patient Phone* Patient Date of Birth* Gender*

Diagnosis* Reason for Referral*

Preferred Appointment Type*

Preferred UT Southwestern Provider* Insurance Provider (Optional)
If not listed, your insurance provider is not currently accepted.

REFERRING PROVIDER INFO