Child Wellness Clinic
Refer a Patient
Appointment availability
Updated January 2023.
We are accepting new referrals.
Referral requirements
Please submit a referral that is complete. This helps us schedule your patient’s appointment in a timely manner and ensure their first visit is smooth and productive.
We may not schedule patients until a complete referral is received.
Please include:
- Reason for referral: what is the clinical question for the specialist?
- If the referral is urgent (see within 4 weeks) or routine (next available)
- ICD-10 Diagnosis – required
- Visit type:
- New patient consult, transfer of care, second opinion, or return visit/ongoing care
- ALL relevant clinical documents
- Clinic notes
- Medication history
- Growth charts/curves
- Lab reports
- Imaging and diagnostic reports
- Previous specialty evaluations
- Patient’s full name (legal name and chosen name, if different), DOB, sex, address, guardian contact information and insurance
- Referring provider’s name, phone, fax and the referral coordinator’s email address so that we may contact you if additional information is needed
- Preferred clinic location, if applicable
- If an interpreter is needed
- Any known barriers to performing a successful telehealth (video) visit with the family
Submit a referral
- New Appointment Request Form (PDF) (DOC)
- Step-by-Step Guide to Submitting a Referral
- New Patient Referral FAQ
Please call our Clinical Intake Nurses if you need assistance: 206-987-2080.
Provider-to-provider communication
- If you are directing or transporting a patient to the Emergency Department or Urgent Care, please call Mission Control at 206-987-8899 or 866-987-8899 (toll free).
- For non-urgent clinical questions related to a shared patient, please call 206-987-8080, option 4.
- For co-management questions related to an existing problem for a shared patient, please send an InBasket message via EpicCare Link.
- If you would like to have one of our Pain Medicine team members provide in-person or virtual education with your clinic, please contact our Physician Relations team to coordinate.