Thank you for your continued confidence and your ongoing referrals! In an effort to ensure that we are able to easily correspond with your office (and keep you informed of your patient’s care while here at the OMFS Care Center), we ask that you use the referral form provided below to notify us of your referrals. Just fax a completed form for each patient to us at (559) 459-5744. The security and privacy of your patient’s data is one of our primary concerns and we have taken every precaution to protect it.
PLEASE MAKE SURE TO INCLUDE ON THE REFERRAL THE REFERRING DOCTORS RENDERING PROVIDER NPI # AS WELL AS THE ORGANIZATIONAL NPI # IF APPLICABLE.
If you have taken x-rays of your patient, you may e-mail them to our office. Our administrative e-mail address is email@example.com If there is not enough time, please have your patient pick them up and bring them to our office. If additional films are necessary, they can be taken at our office.
Mac Users - it is important to have the latest version of Adobe Acrobat Reader on your computer in order to view this form. If you do not have it, please download the free plug-in from Adobe's web site. You Must OPEN the Adobe Reader Application after installation and make Adobe Reader your DEFAULT SAFARI PLUGIN for Viewing PDF Files.
PC Users -Our online form uses the latest version of Adobe Acrobat Reader to conveniently submit the form from home or work. Please download the free plug-in from Adobe's web site if it is not already installed on your system. It is important that you have at least version 9 of the plug-in to successfully use our online form.