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Refer A Patient

Create a method for monitoring referral report due dates, so that reminders can be sent. This also documents that the patient is being followed during the referral period. Conduct quarterly audits to determine if there are specific physicians who are not timely. If you find a physician is inexpedient, consider referring future patients to a different specialist.

    Referring Doctor’s Details

    Doctor's Full Name

    Doctor's Email ID

    If you would like to have a digital copy of your receipt or reports, please input your primary email ID.

    Doctor’s Mobile Number

    Please input your primary mobile number so that our representative can contact you to confirm your appointment.

    Patient Details

    Patient's Full Name

    Patient's Email ID

    If you would like to have a digital copy of your receipt or reports, please input your primary email ID.

    Mobile Number

    Please input your primary mobile number so that our representative can contact you to confirm your appointment.

    Reports (optional)

    Sharing reports from previous appointments will help the doctor give you a more accurate diagnosis. Maximum of 5 files can be uploaded and it needs to be in PDF format and should not exceed 5mb per file.

    Hospital Referred To

    Location

    [hospitals]

    Doctor (Optional)

    [doctors]

    Captcha 20 + = 28

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