1. Please download or print our Queen’s Heart Referral form
2. Send completed form along with requested medical documentation outlined on form to our fax line or email.
3. Please call (808) 691-8900 if you have additional questions or concerns with how to submit a referral.

• Referrals to the Queen’s Heart Institute can be ordered through CareLink (EPIC)
  • Via order entry, select “Referral to cardiology”
  • Please select internal referral and the department you would like to refer to. (E.g. Queen’s Heart Physician Practice for General Cardiology, location QMC punchbowl)
  • If you have a preferred provider in mind, please indicate in the referral order
  • Please state an indication for referral.
• Our office will contact you if any additional documentation is needed outside of CareLink (EPIC) records.

Please have the medical professional overseeing your care submit a referral request.