How to Make a Referral to CHAP 

Referring a Patient at Cardinal Glennon Children's Medical Center

• University Pediatrics
• Click here to complete the referral form.
• Give the referral form to the paitent-family to take to the registration desk to receive a CHAP appointment.
• Other Cardinal Glennon Departments
• Click here to complete the referral form.
• Give the bottom of the referral form to the patient to call to schedule their CHAP appointment
• Fax the top portion of the referral form to CHAP at 314.534.1028.

Referring a Patient at Grace Hill Neighborhood Health Centers

• Child Developmental Center
• Click here to complete the referral form.
• Give the referral form to the patient-family’s social worker to schedule a CHAP appointment.
• Place the referral form in the CHAP mailbox
• Other Grace Hill Departments
• Click here to complete the referral form.
• Give the bottom of the referral form to the patient to call to schedule their CHAP appointment
• Fax the top portion of the referral form to CHAP at 314.534.1028.

Referring a Patient at St. Louis Children’s Hospital

        • Adolescent Center
                o Click here to complete the referral form.
                o Give referral form to patient-family’s social worker to schedule a CHAP 
                appointment on Wednesday or Thursday, 9am-5pm.
                o Give bottom portion of form to patient as a friendly reminder of appointment 
                date and time.

        • Hematology / Oncology Department
                o Click here to complete the referral form.
                o Give referral form to patient-family’s social worker to schedule a CHAP 
                appointment on Wednesday or Thursday, 9am-5pm.
                o Give bottom portion of form to patient as friendly reminder of appointment 
                date and time.

        • Healthy Kids Express
                o Click here to complete the referral from.
                o Give the bottom of the referral form to the patient to call to schedule their 
                CHAP appointment