Health-related social needs (HRSNs) may impact the receipt of genetic services, but the mechanisms are not well established. We aimed to evaluate the relationship between pediatric patients’ HRSNs and referrals for genetic evaluation. We analyzed HRSN survey data collected during clinic visits across 47 primary care offices for children <3 years of age. Using hazard ratios adjusted (aHRs) for child characteristics, we evaluated the relative likelihood of referral for genetic evaluation based on categories of HRSN.