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Refer A Patient to Otolarygnology

Now Taking Physician Referrals

To refer your patient, please fill out the form below and click on the button labeled "Submit." We will contact you within 24-48 hours.

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Providers Outside Ï㽶ÊÓƵ of Utah Health

Fax voice disorder referrals to 801-587-3569. Fax otolaryngology and audiology referrals to 801-585-2500. 

Referring Provider Information
Patient Information
Name
Address
Please help us understand your patient's medical history. Has your patient had any of the following tests?
Audiogram
CT
MRI
Other Testing
Would You Like to Request a Specific Provider?
Primary Insurance Information
Secondary Insurance Information