A referral is a recommendation from your pediatrician to see a medical specialist when further evaluation of a particular issue is necessary. In most cases, a pediatrician will make such a recommendation after they and the parents have collectively exhausted resources for addressing the issue. This is not only for the sake of limiting unnecessary work-ups, but is a requirement of most insurance companies. Per these requirements, your pediatrician must have had to make a diagnosis associated with the issue in order to move forward with a referral.

Knowing which specialist would be appropriate for any given circumstance depends on many factors, and is the task of the pediatrician to determine after their evaluation, not the parents. If your pediatrician has suggested the possibility of referral to a specialist for an ongoing issue and you have chosen to proceed or were asked to request a referral when you called to schedule an appointment, use this form.

If your child has never been seen by your pediatrician for a particular issue and you use this form to request a referral, it is likely that they will ask you to schedule an appointment for further discussion before they refer you.

In some cases, a doctor will make provide an informal referral for a specialist that provides regular care; you may use this form to ask your pediatrician who they would recommend as an optometrist or dentist, for instance.