To request an appointment for your patient by fax, please print and return these forms:
Referring physicians - use this form to schedule a radiology appointment with our Phoenix Children's Medical Group Radiologists.
Radiology referral form (PDF)
Main number: (602) 933-1213
Radiology scheduling: (602) 933-1215 Fax: (602) 933-1214
Interventional scheduling: (602) 933-4444 Fax: (602) 933-1587
Surgeons - use this form when scheduling patients for surgery in Phoenix Children's operating rooms.
Surgery referral form (PDF)
Surgery Scheduling: (602) 933-1530
Surgery Fax: (602) 933-1553
Not sure about authorizations?
List of common procedures requiring authorization, listed by health insurance company (PDF)
Specialty Service Referral Form
Fill out this secure, electronic form and we'll take care of the rest. You'll be notified as soon as your patient's appointment is scheduled.