Refer a Patient: Echocardiography Imaging Program

How to Refer a Patient

1. Gather required documents

• A copy of your patient's insurance card and authorization
• Clinical documentation, including reports and images from previous cardiac testing and procedures

2. Fill out the referral form

Download the Pediatric Cardiology Referral Request Form. It's a fillable PDF, so you can complete it on your computer screen.

Download referral form

3. Fax everything to (415) 353-4485

Send the completed referral form and required documentation, using this fax number for all clinic locations: (415) 353-4485.

Where to Call for Help

If you have questions, please call the Pediatric Heart Center:

M-F, 8 a.m. - 4:30 p.m.
(415) 353-2008 (San Francisco)
(510) 428-3380 (Oakland)