Referral Forms

If you would like to refer your patient to the INTEGRIS Nazih Zuhdi Transplant Institute, please select the appropriate referral form.

• Kidney/Pancreas Referral Form
  Please fax the completed form to 405-815-6404.
• Transplant Evaluation/Hepatology/Hepatobiliary Surgery Referral Form
  Please fax the completed form to 405-713-7643. If you have questions, please call 800-991-3349.
• Lung Referral Form
  Please fax the completed form to 405-552-0450. If you have questions, please call 405-951-8191.
• Advanced and General Gastroenterology Referral Form
  Please fax the completed form to 405-815-6172. If you have questions, please call 405-949-3349. 
• Self Referral Form
  Please fill out and submit this living donor eligibility form.