There are several ways to refer an exam to Olympic Radiology.  You can:

	Contact our office at (360)479-6555 to schedule the appointment then give the referral form to your patient to bring with them to their appoinment.
	Fax a referral form to us at (360)479-8327 and ask your patient to contact us to arrange a convenient time for the exam.
	Fax a referral from your EMR system.

TIP:  If you include the patient's phone number, we will make attempts to contact them as well.

Olympic Radiology can accommodate same day appointments in most modalities.  Please be aware, however, that many of our exams have preparation instructions and for those exams, same day appointments may not be appropriate.

Olympic Radiology also staffs a “walk-in” x-ray room for plain film x-rays, between the hours of 8:30am-5:00pm.  Patients are taken on a first come, first served basis and will be accommodated in the timeliest manner possible.  Patients must bring with them a written referral from their practitioner.

Patient Demographic Information:
	Patient Name
	Date of Birth
	Phone number for contact
	Insurance information

Clinical Information:
	Exam being ordered
	Presenting symptoms or condition
	Any prior exams of the same anatomical area for comparison?

Other Information:
	Are there other practitioners that need to get copies of the results?
	Special Instructions for our Radiologist:   - Stat read w/ a call report - Hold patient for further instructions once results are available.
	Does the patient have any special limitations or conditions that we should know about:   - Physical limitations such as paralysis - Diabetes or Kidney disease - Claustrophobic - Language barrier