Referral Forms

To request an appointment for your patient by fax, please print and return these forms:

Referring physicians - use this form to schedule a radiology appointment with our Phoenix Children's Medical Group Radiologists. 

Radiology referral form (PDF)

Main number: (602) 546-1213

Radiology scheduling: (602) 546-1215  Fax: (602) 546-1214

Interventional scheduling: (602) 546-4444  Fax: (602) 546-1587

Surgeons - use this form when scheduling patients for surgery in Phoenix Children's operating rooms.

Surgery referral form (PDF)

Surgery block scheduling form (PDF)

Surgery Scheduling: (602) 546-1530

Surgery Fax: (602) 546-1553

Not sure about authorizations?

Links to health insurance plans (PDF)

List of common procedures requiring authorization, listed by health insurance company (PDF)

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Related links

Procedures requiring authorization

Insurance authorization links