Forms for Physician's Offices
Outpatient Testing Form
Physician/Staff: To avoid delays for your patients, this form should be completed in its entirety including the physician signature, diagnosis code/description, and procedure. We will verify that ordered test(s) will meet necessity criteria. Should there be any discrepancy we will contact you. It the procedure/exam can be completed with or without contrast materials, the order must specify WITH or WITHOUT CONTRAST.
Please fax these orders for scheduling purposes to 903-798-7887. Please send these throughout the day rather than collect them and send once so that our staff will better be able to meet the needs of you and your patient. If you have trouble with the fax number, please contact us at 903-798-8900.
 - Outpatient Testing Form
Pre Admit Testing Instructions for Surgical Procedures
Physician/Staff: Please instruct patient to bring this form when registering within 4 to 7 days prior to their surgery date. The Patient may call and schedule an appointment time (903) 798-7646.
- Pre Admit Testing Instructions for Surgical Procedures
GI LAB - Referral Form
Physician/Staff: Please fax a copy of the patient's insurance card, front and back, and the most recent office notes, along with this form to: 903-798-8862, we will then contact the patient to set up the appointment.
- GI LAB - Referral Form
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