Refer a Patient to a Pediatric Specialist

Refer your patient to a pediatric specialist at SSM Health Cardinal Glennon Children’s Hospital using our online pediatric referral form. We have more than 200 pediatric specialists in more than 60 specialties, including pediatric cardiology, pediatric heart surgery, diagnostic imaging, pediatric gastroenterology, and more.

Visit the Access Center for physician consults, direct admits, transfers and urgent appointments.

If your patient is experiencing a medical emergency, please call 911.

Due to access and intake processes, some specialties request that patients call to make an appointment. These specialties include:

Allergy & Dermatology: direct patients to call 314-268-4010
Developmental Pediatrics: direct patients to call 314-577-5609 or refer patient to the Knights of Columbus Developmental Center
Psychology or Psychiatry: direct patients to call 314-577-5667 or refer patient to the Knights of Columbus Developmental Center

Refer a Patient

For neurology, please complete the neurology referral form. For additional specialties, fill out the form below. Once submitted, a hospital representative will call the patient to schedule the child’s appointment within three business days.

Referring Provider Name

Referring Provider Office Address

Referring Provider Phone Number

Please enter phone number as XXX-XXX-XXXX

Referring Provider Email Address

Select the type of care your patient needs *

For neurology, please complete the neurology referral form.

Patient's First Name *

Patient's Last Name *

Birth Date

Please enter as MM/DD/YY

Parent or Guardian's First Name (if patient is under 18) *

Parent or Guardian's Last Name (if patient is under 18) *

Parent or Guardian's Phone Number *

Please enter phone number as XXX-XXX-XXXX

Address *

Address 2

City *

State *

ZIP *

Please enter a five-digit ZIP code

Reason for Referral

I have read the Notice of Privacy Practices. *

address1

Refer a Patient to a Pediatric Specialist

Refer a Patient

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