Refer a Patient to a Pediatric Neurologist

Submit a Neurology Referral Request

For specialties, please complete the specialty referral form. For neurology, fill out the form. A hospital representative will call the patient to schedule the appointment within three business days.


Patient Information

Please enter as MM/DD/YY
Please enter phone number as XXX-XXX-XXXX
Please enter a five-digit ZIP code

Referring Information





Reason for Referral

















Prior Testing Completed

















brain scans


Additional Referral Information

Refer your patient to a pediatric neurologist at SSM Health Cardinal Glennon Children’s Hospital using our online pediatric referral form.


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


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


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