Please click on the type of patient referral you need to download a printable form. Each form should be faxed to the corresponding department fax number.
To expedite the referral process, please send demographics, insurance, all prenatal records/lab results and the appropriate signed order form for each. Also, please note that insurance companies require the ordering physician’s office to request procedure authorizations.
Fetal Care Center
- for comprehensively supportive care for any patient with suspected or confirmed fetal diagnosis
Maternal Fetal Medicine/ Ob Ultrasound
- for traditional care for privately insured patients with maternal indication
High-Risk OB Clinic, Teen Pregnancy Center or the Center for Diabetic Pregnancy
- for comprehensively supportive, safety net care for publicly insured and uninsured patients with maternal indication
Washington University Genetic Counseling
- for pregnancies with advanced maternal age or abnormal maternal serum screening
St. Louis Children’s Hospital Fetal Heart Center
- for family or sibling history of heart defect, maternal diabetes
For emergent maternal transport with our Maternal Fetal Transport Team, or an urgent telephone
consult with a Maternal Fetal Medicine specialist, please call 800-678-HELP (6357).