Referral Forms for Providers

Thank you for referring your patient to us. Use the button below or call UK-MDs at 800-888-5533.


EpicCare Link is the preferred method for submitting online referrals. Other online referral forms will be taken down soon. If you currently do not have access to EpicCare Link, please complete an application by clicking here. In order to submit a referral or receive patient notifications, the provider must also have a completed EpicCare Link application on file. For more information, please contact the Physician Liaison Program at 859-323-0736.

Department-specific referral forms

If referring a patient to one of the areas below, complete and submit the department-specific form only. You do not need to complete the standard form.

If you are a patient, please use our appointment form.

Interventional Pain Medicine referral form

Markey Cancer Center

Nephrology Hypertension

To make a patient referral, please complete the following form and fax it to 859-257-0260.