REFERRAL SLIPS /ORDER FORMS

Here is our referral slip in a PDF format. To view this file you must have Adobe Acrobat installed on your computer. If you don't please click on the button to the right to download Acrobat.

Click Here to Download Our Referral Slip

 

SCHEDULING AND PRE-AUTHORIZATION FAX REQUEST FORM

Use this combination form if you prefer to have RDC contact your patient to schedule an appointment and obtain authorization for the exam.  No additional Referral Slip is necessary if the physician signs the bottom of this form.

Click Here to Download Our Scheduling and Pre-Authorization Fax Request Combination Form