Fill out a referral form or provide notes.

Use your own referral form/notes* or download one of our forms:

• Adult referral form
• Pediatric referral form
• Imaging referral form

Use our search tool to find the checklist you need. It lists records we must have before the appointment. Can’t find one for your patient’s condition? Please start your referral by faxing the following to 503-346-6854:

• Any records that support your referral diagnosis
• A referral form/notes

Gather and fax all materials.

Gather the records listed on the checklist, including any from other providers. Fax the records and the referral form/notes to 503-346-6854  

* Referral forms should include:

• Patient name, date of birth, sex, address and phone number
• Referring provider’s name, address and phone number
• Diagnosis or reason for referral
• Department patient is being referred to
• Most recent chart notes supporting the diagnosis or reason for referral