WARF - Outpatient Request Form

This application does not allow for attachments. If you have attachments to send with your request, please log in and use Care Affiliate to submit your authorization or referral request.

Note: If you are unsure what to select in the "Request Profile" section, please use the Request Profile Guide to help. 

We also offer a step-by-step guide to using WARF.

To improve usability, changes to this tool are coming soon. 

 = Required Field



Requesting Provider Details

Click here for Provider Lookup


Priority and Diagnosis


Request Profile


Servicing Provider Details

Click here for Provider Lookup