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45 Mill Street Toronto, Ontario M5A 3R6Tel: 416 869 DERM (3376) Fax: 416 365 SKIN (7546) www.avantderm.comCONSULTATION REQUEST FORM Please indicate to which clinic your patient is being referred:

How to fill out avantderm referral form

How to fill out avantderm referral form

1. Open the avantderm referral form by visiting their website or requesting a physical copy.
2. Read the instructions and provided information on the form carefully.
3. Start filling out the form by entering the patient's personal details, such as name, date of birth, and contact information.
4. Provide the referring physician's name, contact details, and any relevant medical records or test results.
5. Indicate the reason for the referral and the specific services or treatments needed.
6. Include any additional notes or special instructions for the receiving dermatologist.
7. Review the completed form to ensure all necessary information is provided and accurately filled out.
8. Submit the referral form as per the instructions provided, either by mailing it or submitting it online.
9. Follow up with the receiving dermatologist or avantderm to ensure the referral process is successful.

Who needs avantderm referral form?

1. Patients who require specialized dermatological care may need avantderm referral form.
2. Primary care physicians who wish to refer their patients to avantderm for further evaluation or treatment.
3. Other healthcare professionals who believe their patients would benefit from avantderm's expertise and services.

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What is avantderm referral form?

The avantderm referral form is a document used to refer patients to dermatology specialists for evaluation or treatment.

Who is required to file avantderm referral form?

Healthcare providers who wish to refer patients to dermatology specialists are required to file the avantderm referral form.

How to fill out avantderm referral form?

To fill out the avantderm referral form, providers need to enter patient details, reason for referral, and any relevant medical history or documentation.

What is the purpose of avantderm referral form?

The purpose of the avantderm referral form is to streamline the referral process and ensure that specialists have the necessary information to assess and treat patients.

What information must be reported on avantderm referral form?

The avantderm referral form must include patient identification information, referring provider details, medical history, and the reason for referral.