Introduction: Pediatric primary care providers (PPCPs) play an increasingly important role in addressing mental health concerns. Yet PPCPs are limited in the services they can provide because of constraints in training, time, and reimbursement. Whereas some patients may be appropriately treated in primary care, others require referrals to mental health specialists. The current study evaluated patient, clinician, and situational factors associated with PPCPS’ reported likelihood to refer hypothetical patients with mental health concerns to mental health specialists. Method: The sample included 106 PPCPs from Massachusetts and Indiana who read one of two vignettes of hypothetical patients (one with symptoms of attention-deficit hyperactivity disorder (ADHD) and one with symptoms of depression) and then completed surveys regarding patient diagnosis and treatment decisions. Results: Results indicated that PPCPs who read the depression vignette were significantly more likely to report intentions to refer the patient to a mental health specialist than those who read the ADHD vignette as were PPCPs with less confidence in treating mental health concerns. PPCPs who read the depression vignette were also more likely to report intentions to refer to psychologists and social workers as opposed to PPCPs who read the ADHD vignette, who reported intentions to refer to psychiatrists. Training in developmental and behavioral pediatrics was not related to reported likelihood of referring. Conclusion: These findings illuminate potential areas for future research on referral patterns from primary care to mental health specialists.