Referral Forms for Physicians

For all of our referring physicians, for your convinance our referral forms are listed below.

The form listed “Referral Form-Office Visit” is for an appointment with one our physicians. Demographics, chart notes and any test results should be sent with this form. Once we receive the information in our office we will reach out to the patient and get them scheduled, we will fax your office a letter with the appointment date and time for your records.

The form listed “Ultrasound Order” is for ultrasound only appointments. Same day appointments are avaible for urgent exams, non-emergent exams will be scheduled within 5 days of reciept of the order. This order is for the test only and not a visit with the physician. Once the test has been completed our sonographer will immediately call with a preliminary report.

If you have any questions you can call our office at 229-226-0125 or email us at info@vitadr.org