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
Patient honors Fargo home health nurse with DAISY Award
Katherine Uhlir, RN, noticed an infected wound during an in-home visit
background-image
Good Samaritan Society featured in book about long-term care
Book by AHCA/NCAL leaders shares strategies of top skilled nursing providers

View All News

Classes & Events

background-image
Birthing with Confidence

Sat 12/21/24 9:30 AM - Sat 12/21/24 3:00 PM
Online class
background-image
Postpartum: Adjusting to a New You

Sun 12/22/24 1:00 PM - Sun 12/22/24 3:00 PM
Online class

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

Patient honors Fargo home health nurse with DAISY Award

Good Samaritan Society featured in book about long-term care

Classes & Events

Birthing with Confidence

Postpartum: Adjusting to a New You

expand menu button

expand menu button

expand menu button

expand menu button