Specialized Referrals & Contacts

Most referrals can be made online. Some services need specialty forms sent by fax.

General Referrals

You can refer a patient (adult or pediatric) using the online referral form.

Specialty Forms for Referrals

A few services require additional information. Refer your patient for:

• Endocrinology referral (PDF)
• Kidney care/Nephrology referral (PDF)
• Pulmonary care (PDF)
• Gastroenterology and endoscopy: Digestive health referrals
• Radiosurgery: Gamma Knife referrals
• High-tech scans: Radiology & imaging referrals
• Lung cancer: Screening referrals 
• Organ transplant: Transplant referrals

Referring COVID-19 Patients for Monoclonal Antibody (mAb) Infusion Therapy

mAb Infusion therapy is offered in the UVA COVID-19 Clinic under FDA Emergency Use Authorization (EUA) for patients with mild-to-moderate symptoms for fewer than 10 days who are at risk for progressing to severe disease and hospitalization.

To refer a patient:

1.   Complete all sections of this referral form (PDF).
2.   Submit the referral form by fax to 434.243.9800.

Our team will then review the referral, and, if approved for infusion, we will contact the patient to coordinate services.