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

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Provider Information

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Patient Information

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Example: 555-123-1234


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