Healthcare Professionals: How to Refer to CHOP

The Global Patient Services Program at Children's Hospital of Philadelphia (CHOP) has expertise in handling referrals and transferring cases from physicians around the world. To refer a patient, you can:

Fill out the Referral Form below with as much information as possible.
Call us at 001-267-426-6298 (Business hours are from 8:30 a.m. – 5 p.m. North American Eastern Standard Time)
In all cases, a bi-lingual representative from the IPS program will contact you within 24 hours to discuss your patient.

This form is not to be used in the case of an emergency. If this is a medical emergency, please call 911 or your local emergency access provider.

Patient Information*First Name

*Last Name

*Patient Date of Birth:

(mm/dd/yyyy)

Referrer Information*Physician First Name

*Physician Last Name:

*Phone

*Email

*How did you hear about us?

Other

*Country Name

Best time to contact you by phone?

Appointment Information*Reason for Appointment

*Diagnosis:

Additional Information:

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Healthcare Professionals: How to Refer to CHOP

Department of Global Medicine

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Department of Global Medicine