Get Referral Form.indd - Medpoint

Filling out the Referral Form online is a straightforward process that helps ensure patients receive the appropriate medical care. This guide provides clear and concise instructions to assist you in completing the form accurately.

Follow the steps to fill out the Referral Form effectively.

1. Press the 'Get Form' button to access the Referral Form and open it in your preferred digital environment.
2. Begin by entering today's date in the designated field to record when the referral is made.
3. Input the patient's full name in the 'Patient’s name' section. Ensure correct spelling for accuracy.
4. Select the patient's gender by marking the appropriate box for either Male or Female.
5. Fill in the patient's date of birth (D.O.B) in the specified format (MM/DD/YYYY).
6. Complete the health card number and address fields, including the city and postal code to facilitate communication.
7. Provide the patient's phone number and cell number if available, making sure the area codes are included.
8. Detail the patient history or reason for referral in the 'Patient history / Reason for referral' section, ensuring that any required areas are filled out.
9. Choose the relevant specialty for the referral by selecting the appropriate checkbox from categories like Cardiology, Neurology, Gynecology, Dermatology, Pediatrics, General Surgery, or Plastic Surgery.
10. Fill in the referring physician's details, including name, signature, billing number, phone number, address, and fax number.
11. Review the entire form for accuracy and completeness. Ensure all required fields are correctly filled, as incomplete forms will not be processed.
12. Save your changes, and utilize the options to download, print, or share the completed form as needed.

Complete your documents online to ensure the best possible healthcare experience.