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500 Davis Street Suite 601 Evanston, IL 60201 P. (847) 4923492 F. (847) 4923499 www.dentalprofofevanston.com Dr. Richard The Dr. Vienna PhillipsPATIENT REFERRAL Introducing:Date:Date of Birth:Phone
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How to fill out referral to our office
How to fill out referral to our office
01
Start by visiting our website and navigating to the 'Referral' page.
02
Download and print out the referral form.
03
Fill out the form with the necessary information, including the patient's personal details, medical history, and reason for referral.
04
Make sure to include any relevant supporting documents or medical reports with the referral form.
05
Once the form is complete, you can either mail it to our office or drop it off in person.
06
If you prefer an online submission, you can also scan the filled form and email it to our designated email address.
07
After receiving the referral, our team will review the information and contact the patient to schedule an appointment if necessary.
Who needs referral to our office?
01
Anyone who requires specialized medical care or services that our office provides may need a referral.
02
This can include patients with complex medical conditions, those seeking a second opinion, or individuals requiring advanced diagnostic tests or treatments.
03
Referrals are typically made by primary care physicians, specialists, or medical professionals who believe their patients would benefit from our expertise.
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What is referral to our office?
A referral to our office is a formal request for assistance or services that indicates the need for action or review by our team.
Who is required to file referral to our office?
Individuals or organizations who need assistance or have a case that requires our office's attention are required to file a referral.
How to fill out referral to our office?
To fill out a referral, complete the provided form with necessary details such as the nature of the request, relevant information about the individual, and any supporting documentation.
What is the purpose of referral to our office?
The purpose of a referral is to facilitate the process of obtaining services or interventions needed by individuals, ensuring that cases are handled appropriately.
What information must be reported on referral to our office?
The referral must include identifying information of the individual, a description of the issue or need, supporting documentation, and the referring party's contact information.
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