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Multidisciplinary Sarcoidosis Program

Refer a Patient—Multidisciplinary Sarcoidosis Program

Call 801-585-5122

Now Taking Physician Referrals & Self-Referrals

U of U Health's multidisciplinary Sarcoidosis Program is here to assist community physicians and specialists with consultation and referral services. To refer yourself or a patient, please fill out the information below and click on "Submit". You will receive a response within 24–48 business hours.

Please be aware, we can only respond to your request during normal business hours, 8 am–5 pm, Mon–Fri.

Learn more about patient safety precautions, virtual visit options, and referring physician resources.

Patient Information (For Self-Referrals & Provider Referrals)

Full Name (First, Last)

Date of Birth ^*

Gender

Female

Male

Other…

Enter other…

Address

City/Town

State/Province

ZIP/Postal Code

Phone Number ^*

Email Address

Insurance Information

Primary Insurance Name ^*

Policy Holder's Name

Policy Number

Group Number

Phone Number

Referring Provider Information

Referring Provider Full Name (last, first) ^*

Referring Provider Phone Number ^*

Referring Provider Office Fax Number

Referring Provider Email Address

Referring to Information

Diagnosis/Reason for Referral ^*

Type of Referral

Self-Referral

Provider Referral

Specialty Referral Is Requested For

Pulmonary

Dermatology/Skin

Renal/Nephrology

Rheumatology (Self-referrals are not accepted. Provider referrals only.)

Cardiology

Neurology

Ophthalmology

Urgency Rating

Urgent 24-hour contact

Routine 48-hour

Submit or call 801-585-5122 for questions about this referral.

Leave this field blank

50 North Medical Drive
Salt Lake City, Utah 84132

801-581-2121