Referrals for care through TLH are only for adult patients with suspected or established liver disease, including those needing pre-transplant evaluation, optimization prior to transplant referral, or post-transplant liver-related care.

We do not accept referrals for general gastroenterology concerns (e.g., reflux, IBS, abdominal pain, diarrhea/constipation, or routine GI complaints).

Secure Fax (Preferred)

Please fax referral information, recent clinic notes, labs, and relevant imaging reports to:

Fax: (833) 764-5608

Online Referral Form (Alternative)

If faxing is not feasible, you may submit the basic referral details using the form below. Our team will contact the patient to arrange an appointment and will follow up with your office as needed.

Referring Provider Information

Referring Provider Name *

Practice Name

Provider Phone Number *

Provider Fax Number

Provider Email *

Patient Information

Patient Full Name *

Date of Birth *

Patient Phone Number *

Patient Email

Insurance Information

Reason for Referral / Consult

Reason for Referral / Consult *

Clinical Information

Clinical Summary / Key Details *

Urgency *

Documentation Reminder

Please fax supporting documents (clinic notes, labs, imaging reports) to (833) 764-5608.

File uploads are not accepted through this form.

Provider Referrals