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UI Consult 1-800-322-8442
General Information and Instructions for Referral Form
This form has been designed to simplify and
expedite the referral of patients to The University of Iowa Hospitals
and Clinics and members of its clinical staff. It may be used to
refer all patients, regardless of financial status, to University
Hospitals. In addition, telephone inquiries regarding admission or
outpatient appointments are welcomed and may be direct dialed to the
appropriate clinical service number indicated on the Physician's Desk
Reference Guide supplied to all referring physicians.
The University of Iowa Hospitals and Clinics requests this
information for the purpose of providing medical and demographic
information. No persons outside The University of Iowa Hospitals and
Clinics are routinely provided this information, unless authorized by
the patient's consent. If the person completing the form fails to
provide the required information, it may result in delay in acquiring
an appointment.
Patient Referral Form
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