Physician Request for Referral to the Department of Surgery at UC Davis Medical Center

Please complete the following information to contact our Physician Referral Center to initiate a referral on behalf of your patient or to request a physician-to-physician phone consultation.

We will respond to your request by close of the next business day. If you prefer, you can call us at (800) 4-UCDAVIS, option #2, between 8 a.m. - 5 p.m., Monday through Friday.

All fields marked with an asterisk (*) are required.

	Refer a patient
	Physician-to-physician phone consultation
	More information about:
Your last name:*
Your first name:*
Your phone number:*
Your E-mail:
Best time to reach you:
Alternate contact name:
Alternate phone:
UC Davis specialist's name:
UC Davis specialty service requested:
ENTER NUMBER: *

Physician-to-Physician Request for Referral or Consultation