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.

Gender of patient
Does the patient live in the US or Canada?
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
SCCA should...
CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

2 + 7 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.