Refer a Patient: General Surgery Parnassus

Complete and submit our online referral form, which conveniently auto-fills some provider-related fields.

Download our referral form PDF, complete it and fax it to us at the number below.

Sign into MD Link, our secure portal that allows you to easily refer patients to UCSF Health and stay connected to their care. Learn more about MD Link.

You will need:

• A referral letter that includes: the patient’s diagnosis, how long you've cared for them, their current body mass index, and clinically significant comorbidities.
• Demographic page with contact information.
• Copy of insurance card (front and back).
• Authorization (if required) with CPT code 99205.
• Copies of clinical progress notes.
• Documentation of weight-loss attempts for three to six consecutive months during the bariatric workup. It must include the duration of each program, the patient’s initial weight and ending weight, and weight-loss methods attempted (for example: diet and exercise, Weight Watchers or JumpstartMD). Please send notes from consultations with nutritionists or dietitians.

Fax the documents to us at the number listed below.

If you have questions or need assistance, please call the bariatric surgery program and ask to speak with the new-patient coordinator.