Skip to main content
close menu
close menu

Search UK HealthCare

Referral Form for Physicians

Thank you for referring your patient to UK HealthCare. Please fill out and submit the secure form below to begin the referral process.

After you submit this form, you will receive a phone response within 24 hours, excluding weekends and holidays.

Please print this form for your records before you submit it.

You may also refer patients by phone by calling UK-MDs at 859-257-5522 or 800-888-5533.

Referring Provider Information

Provider Request

Patient Information

Gender
Does the patient need an interpreter?

Referral Information

All e-mail referral forms will receive a phone response within 24 hours excluding weekends and holidays. If you do not receive a response in 24 hours, please call us at 800-888-5533 or in Lexington 859-231-9922.

UK-MDs respects the confidentiality of your personal information and promises only to use it for internal purposes as it relates to this request. By submitting this form, you will transmit your details to us safely over a secure network.