Electronic Referral Form Checklist | Patient Referrals | UC Davis Health

Please include the following with your referral:

• Completed UC Davis Health electronic referral intake form
• Recent, relevant clinical notes and test results (e.g., history, physicals, imaging, labs)
• Proof of insurance
• Authorization details (approved CPT codes, number of visits, and valid dates)

Important Notes

• Incomplete or unclear information may delay processing
• Urgent self-referrals are not accepted. Patients must obtain an urgent referral from their primary care provider.