Get Matyo 5072848082

The Matyo 5072848082 is a specialized referral form used by the Mayo Clinic Dental Specialties. This guide provides clear instructions on how to properly fill out the form online for a smooth submission process.

Follow the steps to complete the Matyo 5072848082 form online

1. Press the ‘Get Form’ button to access the Matyo 5072848082 form and open it in your preferred document editor.
2. Indicate the specialty you are referring the patient for by checking one of the options provided under the 'REQUEST FOR SPECIALTY' section.
3. Fill in the patient information section. Enter the patient's last name, first name, middle initial, and date of birth.
4. Provide the patient's complete address, including street address, city, state, and ZIP code.
5. Fill in the home and work phone numbers for the patient, ensuring accurate formatting.
6. Enter the Mayo Clinic number if applicable, and the referring doctor’s name and address.
7. Specify the reason for the referral and the requested doctor’s name in their respective sections.
8. Choose the option regarding x-rays: indicate whether they are not available, with the patient, being mailed, or electronically mailed.
9. Complete the scheduling information by selecting whether the patient needs to be contacted for an appointment, the appointment is scheduled, or the patient will call for an appointment.
10. Review all entered information for accuracy before moving on to save your changes.
11. Once you have verified the information, you can save your changes, download the completed form, and print it if needed.
12. Submit the form by faxing it to 507-284-8082 or sending it as an email attachment to mndentaleexrays@mayo.edu.

Complete your Matyo 5072848082 online for seamless referral processing.