Thank you for referring to Yale Pediatrics. Please fill out the form below and click the Submit button. You will receive a confirmation email shortly after submitting the form. Additionally, please fax pertinent medical records to 203-737-7645. If you would prefer to fax a hard copy of this form, click here to download a pdf. If you have questions please visit our FAQ page or call the Pediatric One-Call Center at 203-785-4081.