Online provider referral form

To refer a patient to Seattle Cancer Care Alliance (SCCA), you may call (800) 804-8824 or complete the form below. SCCA also offers U-Link, a secure system that allows referring providers access to information about their patients.

Refer a patient

Provider
First name Last name Email Email Confirm email Phone number Fax number Are you an SCCA network provider? Yes No Select Network Select Network Enter other…

Patient details

First Name

Last Name

Date of Birth

Does the patient live in US or Canada?

Yes

Insurance

Diagnostic info

SCCA should…

Assume complete management of care

Assume a subset of care (with review and input)

Provide opinion only

Records for patient will be sent by

Mail

Seattle Cancer Care Alliance Intake Office, K-135 825 Eastlake Ave E. Seattle, WA 98109

Fax

Records should be faxed to:(206) 606-1025

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