patient referrals
Dayton Children's is available to assist referring providers and their patients with an array of services. You may refer patients to the hospital, to a particular service or to an individual specialist for consultation, diagnosis or treatment.
referral form options
Please use the forms below to refer to one of our over 30 specialty clinics.
Directly submit online referral for specialty services
- Referral for specialty services
- Children's Home Care of Dayton
- Genetics lab referral form
- Mental Health Resource Connection
- Newborn follow-up clinic
- Rehabilitative services- speech, PT, OT, audiology
- RSV prevention clinic (previously Synagis clinic)
- Psychiatry
- Mental Health Day Treatment Program
- Neuropsychology
- Outpatient therapy
labs, imaging and testing
To order labs, imaging or testing, please use these forms
- Diagnostic testing order form
- Laboratory form
- Medical imaging – main and south campus
- Medical imaging - Springfield Ohio Pediatric Care Alliance
- Outpatient testing center
- PAXLOVID treatment for COVID-19 referral form
