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 (MM/DD/YYYY)*

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

Sanford Health News

background-image
‘Give and take’: Couple shares story of 70 years of marriage
Bill and Arlene Kocourek celebrate milestone anniversary at Good Samaritan
background-image
Managing stress during the holidays
Sanford Health behavioral health therapists offer ways to enjoy a busy time of year

View All News

Classes & Events

background-image
Birth Basics – A Refresher

Mon 12/22/25 6:30 PM - Mon 12/22/25 9:00 PM
Online class
background-image
Caring For Your Newborn

Mon 12/22/25 6:30 PM - Mon 12/22/25 8:30 PM
Sanford Moorhead Campus

View All Classes and Events

Referral Center

Referral Center

The Referral Process

Patient Information

Reason for Referral

Referring Provider Information

Patient's Primary Care Provider

Referral To

Sanford Health News

‘Give and take’: Couple shares story of 70 years of marriage

Managing stress during the holidays

Classes & Events

Birth Basics – A Refresher

Caring For Your Newborn

expand menu button

expand menu button

expand menu button

expand menu button