Click to download
- Referral Form – please fax most recent chart note, imaging reports, and demographics with Rx to 360.604.9293. We will contact the patient within 24 business hours to schedule an appointment.
- Edema DME RX – for ICD-10 I89.0, Q82.0, I97.2, I97.89, please fax to 360-604-9293.