How to Request an Evaluation

The CU CSF Leak Program reviews referral information before scheduling an evaluation so that we can determine whether our program is the right next step and what testing or treatment may be needed. Our goal is to make this process as clear and efficient as possible for patients, referring clinicians, and our care team.

Please note: Sending a referral does not automatically guarantee a clinic visit or a procedure. After review, our team will recommend the most appropriate next step based on the available history, imaging, and records



You must complete all steps below before we will review your case.

1

Step 1

Patients should create a free UCHealth My Health Connection account and upload insurance if applicable. This allows our team to communicate and coordinate care through UCHealth systems.

  1. Go to UCHealth - Access My Health Connection
  2. Click the "Sign Up Now" button
  3. If you have health insurance, make sure to enter your insurance information.
Create a UCHealth My Connection Account
2

Step 2

Your referring provider should send a referral to AMC Neurology with a request for evaluation by the CU CSF Leak Program. 

Referral and supporting documents may be faxed to:

Fax: 720-553-0171

Attention: CU CSF Leak Program

3

Step 3

Outside imaging and records are very helpful and may allow our team to make a more informed recommendation before your visit. If you have prior imaging or procedures related to your symptoms, please send them for review when possible. 

Helpful records include:

  • MRI brain with and without contrast, if previously performed
  • MRI total spine, if previously performed
  • Prior CT myelograms, digital subtraction myelograms, MR myelograms, or other leak-related imaging
  • Imaging from prior blood patches, fibrin patches, or related procedures, if available
  • Clinic notes and procedure notes related to your symptoms
  • Insurance Information
  • Completed CSF symptom report or intake materials, if provided by our team

Imaging reports alone are less helpful than the actual images. When possible, please have the actual imaging studies pushed electronically to UCHealth through PowerShare or mailed on a disc.

Important: We encourage patients to send prior imaging, but lack of complete outside imaging does not necessarily stop the referral process. In many cases, updated imaging or specialized CSF leak imaging will be obtained at UCHealth if the patient is accepted for evaluation. 

Provider Referral Form

 How to Send Imaging


Imaging can be pushed electronically through PowerShare to UCHealth. Patients or outside facilities may also use the UCHealth PowerShare to upload link:

Upload imaging to UCHealth through PowerShare 

Imaging and records may also be mailed to:

University of Colorado
Outpatient Neurology Department
1635 Aurora Ct
5th Floor, Attn: CSF Program
Mail Stop F727
Aurora, CO 80045



 What happens after records are received?

 Contact Us

If you've completed Steps 1 & 2 above and want to check the status of your case, or if you have questions that aren't answered on this page, please call our clinic coordinator at 720-848-2080.

Please understand that our office staff receives a high volume of calls, and your patience is appreciated.

Department of Radiology

CU Anschutz

Leprino Building

12401 East 17th Avenue

Aurora, CO 80045


720-848-0000

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