Get Ultrasound Referral Form

Completing the ultrasound referral form online can streamline the appointment scheduling process for patients. This guide provides clear and detailed steps to assist users in accurately filling out the form to ensure a smooth referral experience.

Follow the steps to fill out the ultrasound referral form online

1. Press the ‘Get Form’ button to obtain the ultrasound referral form and open it for editing.
2. Enter the appointment date and time in the designated fields to indicate when the referral is required.
3. In the referring physician section, provide the physician's name and their clinic or office details.
4. If you need to reschedule or cancel, note the instruction to give at least 24 hours’ notice.
5. Fill in the phone and fax numbers for the referring physician for necessary communications.
6. Input the patient's name, including last name, first name, and middle initial in the appropriate fields.
7. Enter the patient's date of birth in the MM/DD/YYYY format, along with their age and weight.
8. Provide the patient's home phone number for scheduling and contact purposes.
9. For the requested vascular ultrasound order, check all applicable boxes for the procedures needed.
10. In the clinical indications section, describe the reasons for the ultrasound referral clearly.
11. Specify the preferred report delivery method by checking the appropriate box for fax or email, and provide necessary details.
12. Ensure the physician's signature is included, with the date filled out appropriately at the end of the form.
13. Once all fields are completed, save the changes, and use the options to download, print, or share the completed form.

Start completing your ultrasound referral form online today for a hassle-free appointment!