Specialty Patient Referral Forms

Please print and fax the referral forms listed below when you are referring a patient to MUSC Health.

Note: These forms are for use by providers who are referring their patients to MUSC Health.

Most forms are in PDF format. For issues with digital accessibility, please contact Natalie Wessels, wesselsn@musc.edu.

• Adult Hematology Referral
• Digestive Disease Center Consult Procedure Referral Checklist
• GYN Oncology Referral Form
• MOMs Diabetes Referral Request
• Movement Disorders Program 
• New Onset Seizures - Comprehensive Epilepsy Center
• Prenatal Wellness Center Referral
• Vascular & Interventional Radiology Services

Center for Osteoporosis & Bone Health Forms

• Osteoporosis Center Referral 
• Rheumatology Referral 
• Scleroderma Referral 

Pediatric Referral Forms

• Pediatric Gastroenterology Referral 
• Pediatric Infectious Disease Clinic 
• Pediatric Kidney or Liver Transplant
• Adolescent Medicine and Eating Disorders Program Referral

Transplant Referral Forms

• Advanced Heart Failure and Transplant
• Kidney / Pancreas Transplant
• Liver Transplant
• Lung Transplant Referral Form
• Pancreas Transplant
• Post Liver Transplant Follow Up
• Post Renal/Pancreas Transplant Follow Up