Digestive Diseases

How to Refer a Patient

Our partnership with health professionals in the community is key to our success at UCLA Health. It is our goal to assist you with referring a patient to UCLA and ensure they receive the care they need.


By phone

Our locations

We have GI locations across Los Angeles County to serve you

By fax: GI motility and small bowel endoscopy services only

Our motility and small bowel endoscopy services offer referral forms that can be filled out online and faxed to the appropriate service. These forms should not be used for general GI services.

  1. The form serves as fax cover sheet and physician order.
  2. Once the information is completed just fax the form, with records and insurance information, to the number is listed at the bottom of the form.
  3. Please feel free to download the form as you can type directly onto the pdf or make copies for your files.