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
Are you an SCCA network provider?
Select Network

Patient details

Name
Gender
Does the patient live in US or Canada?

Diagnostic info

Patient’s disease type
SCCA should…
Records for patient will be sent by
Seattle Cancer Care Alliance Intake Office, K-135 825 Eastlake Ave E. Seattle, WA 98109
Records should be faxed to:(206) 606-1025

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