Request a Referral

Request a Referral

Please allow three (3) business days for our office to process your request. We accept referral requests Monday through Friday.

Referral requests can be submitted online through your MyJeffersonHealth account. Please be prepared to complete the following fields:

  • Referral Request (Doctor's Name/Procedure Name)
  • Referral Reason (Diagnosis)
  • Facility or Practice Name
  • Number of Visits
  • Date of Appointment
  • Name of Ordering Provider/Specialty

If you do not have online access, you can download the Referral Request Form below, fill it out completely, and submit it by fax to your physician's office, or bring it to your Jefferson Health primary or specialty care office in New Jersey.

If you have a question about a referral, please call 844-542-2273 or your providers office location.