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Refer your patient to the Placenta Accreta Program at UTHealth Houston

The Placenta Accreta Program at UTHealth Houston offers a multidisciplinary approach to the treatment of placenta accreta spectrum (PAS) disorder. Our team provides a full spectrum of services, including prenatal testing, diagnostic imaging, and specialized maternal-fetal care. We closely monitor and provide compassionate care throughout our patients’ pregnancy and delivery.

To refer your patient, please complete the fields below and attach or fax the patient's medical records, including labs, ultrasounds, and patient demographics.

To speak with a clinical specialist about a referral, please call (832) 325-7133.
Referring Physician Name*
First Last
Office Contact Phone*
Referring Physician Phone*
Patient's Name*
First Last
Patient's Contact Phone*
Patient Date of Birth*
Month
Day
Year
Estimated Date of Delivery
Gestational Age
Insurance/Policy Information (if available)
Please provide carrier and policy number.
Referring Diagnosis
Any additional information we need to know?
Health Records File Upload
Accepted file types: pdf, jpg, gif, png, Max. file size: 20 MB.
UT Physicians uses Transport Layer Security (TLS) encryption (also known as HTTPS) for all transmitted data. We also protect all individual internal form data with passwords. Our data is hosted by data centers that are SSAE-16 SOC II certified.
Phone
This field is for validation purposes and should be left unchanged.