Referral Forms

To request an appointment for your patient by fax, please print and return the forms on this page.

Referring Physicians


Main Phone Number: (602) 933-4363
Fax Number: (602) 933-2415


Main Phone Number: (602) 933-0975
Fax Number: (602) 933-4257


Main Phone Number: (480) 835-0709
Fax Number: (480) 962-0523

Physical Medicine and Rehabilitation

Main Phone Number: (602) 933-2263
Fax Number: (602) 933-4256


Radiology referral form (PDF) – Use this form to schedule a radiology appointment with our Phoenix Children’s Medical Group radiologists.

Radiology Main Phone Number: (602) 933-1213
Radiology Scheduling Numbers: (602) 933-1215  Fax: (602) 933-1214
Interventional Scheduling Numbers: (602) 933-4444  Fax: (602) 933-1587


Surgery referral form (PDF) - Use this form when scheduling patients for surgery in Phoenix Children's operating rooms.

Surgery block scheduling form (PDF)

Surgery Scheduling: (602) 933-1530
​Surgery Fax: (602) 933-1553

Not sure about authorizations?

Information about health insurance plans (PDF)

List of common procedures requiring authorization, listed by health insurance company (PDF)

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