Click on the form below. All forms are in the pdf format, fillable using Adobe Reader. You may submit the forms using one of the following:
- Send us the completed form as an attachment to your email, to email@example.com, OR
- Send us the completed form via fax to 559-322-2056, OR
- Print out and have patient bring to the Appointment.
Please email radiographs to firstname.lastname@example.org.
You can also submit a digital referral slip by clicking here..