Patient Referral Refer patients to our office by filling out the below Referral Form. After completing the form, email current x-rays to [email protected]. Referral FormPlease enable JavaScript in your browser to complete this form.Patient Name *FirstLastDOB: *Responsible Party: *Phone Number: *Radiographs:None TakenSent with PatientSent by EmailIn Regards to:Patient Returning to Referring Doctor? *YesNoReferring Doctor: *Referring Phone Number: *Submit Contact Us 5895 Main Street Springfield , OR 97478 P: 541-654-4996 F: 541-790-2338 MAKE AN APPOINTMENT Hours Mon—Fri | 8-4pm Sat & Sun | Closed Rate Us Google