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Step 1: Fax this form, along with the patients referral (if applicable) to fax number above. Step 2: A Referral Coordinator will contact the patient within 24 hours to schedule an appointment with
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Obtain the fax form that needs to be filled out.
02
Fill in all required fields on the form, such as name, address, phone number, etc.
03
Double check the information provided for accuracy.
04
Attach any required documents to the form if necessary.
05
Scan the completed form and any attachments if using an electronic fax service.
06
Enter the recipient's fax number and send the fax.
07
If sending a physical fax, feed the completed form and attachments into the fax machine and dial the recipient's fax number.
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Wait for confirmation that the fax was successfully received.

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Anyone who needs to send important documents or information quickly and securely may need to fax this form.
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Professionals in various industries such as healthcare, legal, real estate, and finance often use fax machines for sending confidential information.
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Fax this form is typically a way to submit documents electronically via a fax machine, often used in business or legal contexts for formal communications.
Individuals or organizations that need to submit formal documents, such as legal forms, tax documents, or official communications, are required to file fax this form.
To fill out the fax form, include the required information in the designated areas, such as sender and recipient details, and follow any specific instructions provided for the content.
The purpose of faxing this form is to ensure that important documents are transmitted securely and efficiently to the intended recipient, often requiring time-sensitive compliance.
The information typically required includes sender's name and contact details, recipient’s information, date of transmission, and any specific content required by the organization or legal entity.
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