Referral Center

The Sanford Health Referral Center connects your patients to the right specialists for their needs. Refer a patient by phone at (844) 851-1515, fax or our online form below.

Records can be faxed to (605) 312-9806.

The Referral Process

1. A physician identifies patient needs.

2. Physician submits referral by phone, fax or online.

3. The referral center finds the appropriate specialist.

4. An electronic referral is sent. The specialty department contacts the patient.

Any information entered on this form is secure and protected according to HIPAA regulations.

Patient Information

Last Name

First Name

Middle Initial

Maiden Name / Alternate Name

Gender

Date of Birth

Primary Phone Number

Alternate Phone Number

Address

City

State

ZIP Code

Insurance Provider

Reason for Referral

Consultation

Medical Diagnosis

Provider Signature

Reason for Request

Referring Provider Information

Last Name

First Name

Middle Initial

NPI

Phone Number

Fax Number

Address

City

State

ZIP Code

Country

Email Address

Patient's Primary Care Provider

Last Name

First Name

Middle Initial

Referral To

Specialty

Provider Name (if known)

Referral Urgency

Preferred Location

Our Doctors

Referral Center

Referral Center

The Referral Process

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