Please use this form if you would like your patient to be seen as an outpatient appointment. When submitted, this form will be sent directly to our email.
You may also download the Outpatient Referral Form and either fax the completed form to 706-310-1323 or email to firstname.lastname@example.org.
The outpatient diagnostic only ultrasound service differs from our regular consultation service:
Clients will not be present during the ultrasound exam.
We would like you to provide a medical history summary and the questions you would like answered on the ultrasound as we will not be obtaining medical history information from the client.
All findings will be sent directly to you (ultrasound interpretation and recommendations). We will not provide any diagnostic information or treatment recommendations directly to the client.
We will not be able to provide extensive follow up consultation on these patients. For any intensive or complicated case, referral through our regular/full consultation service would be more appropriate.