Make an eReferral

To create an Electronic Referral, please complete the form below. All fields are required.

IMPORTANT: Please only click the SUBMIT button once.

When submitting the referral, please be aware of the following:

1. IIAM is accepting Back Up Offers for ALL organs and tissue for research.
2. O.R. time allows IIAM to utilize the researcher’s CIT requirements.  If O.R. is estimated, please clarify in “case notes” section.
3. Please call IIAM directly with any Neonatal offers.
4. Please only click the SUBMIT button once.