Refer a Patient

If you are a UVA Epic user, please place an order through Epic.

Non-UVA Care Provider Referrals

If you are a non-UVA care provider wishing to refer your patient to UVA Health System, use one of the following options below:

Option 1: Call 1.800.552.3723 or 434.924.0434.

Option 2: Provide us with as much information as possible through the form below. A representative will work with the patient to identify any other required information and connect them to the appropriate contact for scheduling. This information may vary depending on the services requested and payor.

For all inpatient and emergency transfers, call 844.XFERUVA (844.933.7882).

Patient Self-Referrals

Are you a patient looking to request an appointment for yourself? Request an Appointment

* required fields

Patient Information

First Name *

Middle Name *

Last Name *

Prior Name *

DOB *

Gender *

Male Female

Patient Contact Information

Primary Daytime Phone *

We will contact the patient at this number to help schedule the appointment.

Patient Notes *

Patient Insurance

Insurance 1 *

Policy Number *

Subscriber *

Insurance 2 *

Policy Number *

Subscriber *

Reason for Referral

Preferred Provider/Department *

Diagnosis *

Purpose of Referral *

Referring Provider Name *

Referring Provider Phone *