Physician Referral Form

Refer a Patient for an Evaluation at National Jewish Health

After you submit the referral, the patient will be contacted by a Lung Line nurse to complete the medical intake and to direct them to the appropriate clinic for scheduling.

If you have questions or would like to speak with someone live, you can contact the Physician Line by phone at 1.800.652.9555 from 8 am to 4:30 pm Mountain time (10 am to 6:30 pm Eastern time) Monday through Friday.

You can also print a pdf version of this form and fax it to 303.270.2162.

Other resources: Physician ConsultationOrder a Test

All information will be submitted through a secure server. Privacy Policy Statement

* Denotes required fields
 

Provider Information

Example: 555-123-1234
Example: 555-123-1234

Patient Information

mm/dd/yyyy
Example: 555-123-1234
Example: 555-123-1234

Newsroom


In the Newsroom, you can find National Jewish Health press releases, newsletters, annual reports and media contacts. Learn more.

Professional Education


We offer Continuing Medical Education to suit a broad range of professional needs and preferred learning styles.

Publications


Lung Cancer Frontiers
This online newsletter offers information about lung cancer and how it can be effectively diagnosed and treated. Learn more.

Connection
This print newsletter offers information about our clinical programs, new faculty and professional education. Learn more.