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Patient Referral Form REGULAR ASAP Please fax to our main office at: (303×4561856 Signature:. Referring Dr. Date:. . Phone & Fax: Patient Name: DOB: Pt Contact Phone #:. . . Interpreter Needed? Yes×No.
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How to fill out please fax to our:

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Start by entering the recipient's name and contact information, including their fax number, at the top of the form.
02
If applicable, indicate the date and time of the fax transmission for reference.
03
Specify the sender's name, contact information, and company details if necessary.
04
Clearly state the purpose or subject of the fax in a concise and descriptive manner.
05
Provide any relevant attachments or supporting documents that need to be included with the fax.
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Verify the accuracy of all the information entered and make sure it is legible and easy to read.
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Double-check that the fax number entered is correct to ensure the document reaches the intended recipient.
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Review the form one last time to ensure that all necessary fields are filled out correctly before sending.
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Place the document in a fax machine and follow the instructions for sending a fax.
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Keep a record or receipt of the fax transmission for future reference if needed.

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Individuals or businesses who need to send important documents or information to another party.
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Please fax to our is a document or information that needs to be sent to our fax number.
Anyone who has been instructed to do so by the recipient or the organization requesting the information.
Please fill out the required information neatly and accurately, then fax it to the specified number.
The purpose of please fax to our is to provide necessary information or documentation in a timely manner.
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