DOCTOR'S OFFICE Patient Referral Refer patients to our office by filling out the below Patient Referral Form & uploading their current x-rays. Patient 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: *Upload X-Ray File(s) Click or drag a file to this area to upload. 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 Payments MAKE A PAYMENT Rate Us Google