Some of our clinics may require a referral from your outside provider. Your provider may request a secure email connection to send us these forms, FAX, or use the physical addresses noted below. Please consult our referral email policy before sending any patient information via regular email.
Advanced General Dentistry (AGD)
AGD Referral Form (PDF)
FAX: 206-616-8545 | Phone: 206-685-8258
The Center for Pediatric Dentistry
Please have your dentist complete a referral form: Pediatric Dentistry Referral Form (PDF)
6222 NE 74th St.
Seattle, WA 98115
FAX: 206-543-0063 | Phone: 206-543-5800
DECOD Clinic
Please visit the DECOD Clinic pages for referral information
FAX: 206-221-5276 | Phone: 206-543-4619
Dental Urgent Care
FAX: 206-221-5276 | Phone: 206-543-5840
Faculty Practice
Faculty Practice Referral Form (PDF)
1959 NE Pacific Street D-453
Box 356365
Seattle, WA 98195
FAX: 206-616-8545 | Phone: 206-685-8258
Graduate Endodontics Clinic
Endodontic Referral Form (PDF) to be filled out by your dentist and emailed to the clinic with a recent periapical.
1959 NE Pacific Street, B-470
Seattle, WA 98195-7448
FAX: 206-616-9786 | Phone: 206-543-3995 | Email: referral@uw.edu
Northwest Center for Oral and Facial Surgery
Please have your dentist or physician complete a referral form: NWCOFS Referral Form (PDF)
Northwest Center for Oral and Facial Surgery
6222 NE 74th Street Box 354916
Seattle, WA 98115-4916
FAX: 206-616-7251 | Phone: 206-543-5860
Oral Surgery Student Clinic
Please have your dentist complete a referral form: Oral Surgery Student Clinic Referral Form (PDF)
1959 NE Pacific Street, D-251, Box 357134
Seattle, WA 98195-7134
FAX: 206-616-7251 | Phone: 206-685-3591
Oral Medicine Clinic/SCCA Oral Medicine Clinic
Oral Medicine Referral Form (PDF)
Oral Medicine Clinic: FAX: 206-616-8577 | Phone: 206-685-2937
Seattle Cancer Care Alliance: FAX: 206-288-1332 | Phone: 206-288-1333
Oral Pathology
Please contact our Oral Pathology Service
Oral Radiology Service
Please visit the Oral Radiology Services page as there are several options for radiographic images.
Graduate Orthodontics Clinic
Orthodontics Referral Form (PDF)
FAX: 206-543-5886 | Phone: 206-543-5787
Graduate Periodontics Clinic
Please have your dentist complete a referral form: Periodontics Referral Form (PDF)
1959 NE Pacific St., B-403, Box 357444
Seattle, WA 98195-7444
Phone: 206-543-5797
Graduate Prosthodontic Clinic
Please FAX a referral and cover letter.
1959 NE Pacific Street, Room B-469
Seattle, WA 98195
FAX: 206-543-7783 | Phone: 206-685-7522