If you prefer to fax this form, click here to download the pdf version.

Medical Specialties
(Please use the referral form for all medical referrals.)
Specialty Phone Fax Special Instructions
860.837.7681 860.837.5361
860.545.9400 860.545.9410 Please call if referring a patient under age one.
860.545.9360 860.545.9365
860.837.5758 860.837.5235
860.837.6700 860.837.6765
860.545.8514 860.545.8661
860.545.9560 860.545.8480
860.837.5759 860.837.5269
860.545.9630 860.545.9622
860.545.9490 860.545.9371
860.545.9395 860.545.8422
860.837.7500 860.837.7550
860.837.5207 860.837.5209
860.837.6350 860.837.5235
860.545.9440 860.545.9445
860.545.9390 860.545.9914
860.837.5890 Please do not fax referrals to the SCAN program. Please call the department directly at 860.837.5890 to discuss the referral first or request a consultation.
860.837.6717 860.837.6702
Surgical Specialties
We will gladly accept either a phone call or the online referral form for Surgical Specialty appointments. Please refer to list below:
Specialty Phone Fax
860.545.8373 860.545.8233
860.545.9100 860.545.9095
860.545.9650 860.545.9214
860.284.0220 860.284.0221
860.545.9520 860.545.9545
860.545.9520 860.545.9036
Other Specialties

To make a referral to Connecticut Children's Sleep Center, please click here.

Please click here for contact information to make a referral to specialties not listed on this page.

Patient Information
You may include a demographic sheet from your computer system by either faxing or uploading through the "Related Documents" section below.

Urgent: Please call the specialty office for urgent appointments. Refer to the specialties section above.

Referring Provider
Is the family aware of the reason for referral?
Would you like a call to discuss the referral prior to the visit?
If you are requesting an MD only visit, please check here and a Physician will return your call to discuss with you.
Collaborative Care
If a co-management protocol is available, please check here to initiate.
Co-Management Plans include a central algorithm, visit templates, and handouts for the PCP and patient/ family. Please check here if you used a Co-Management Plan prior to making this referral:
Referral Guidelines outline when and how to refer to Connecticut Children’s for certain conditions. Please check here if you used a Referral Guideline prior to making this referral:

All collaborative care tools are available at www.connecticutchildrens.org/clasp

Related Documents

If you would like to send an additional referral for this patient please use the "Create Additional Referral For this Patient" button.