Refer a Patient to a Pediatric Specialist

Submit a Specialist Referral Request

For neurology, please complete the neurology referral form. For additional specialties, fill out the form. A hospital representative will call the patient to schedule the 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/YYYY

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

Additional Referral Information

We have more than 200 pediatric specialists in more than 60 specialties, including pediatric cardiology, pediatric heart surgery, diagnostic imaging, pediatric gastroenterology, and more. Refer your patient to a pediatric specialist 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:

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

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