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Send us your referral in three easy steps
1.
DOWNLOAD
MBS Imaging Referral Paperwork
SKILLED NURSING FACILITY PATIENT
HOME HEALTH PATIENT
Endoscopic
Swallow Study
Modified Barium Swallow Study
COMPLETE referral paperwork
2.
In order to see a patient at a facility or at their home kindly submit the following paperwork to us via fax, email, or send it online.
1. Dysphagia Consult Request Form
2. Patient Consent Form
3. Face Sheet from chart
4. Physician Order from chart
FAX: 877-495-7208
EMAIL: reports@mbsimaging.com
ONLINE:
Use your phone or tablet device to transmit each referral page to MBS Imaging.
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Once you add one file, click "add another file" until all documents are uploaded
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Include your email address
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Add any special notes
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Hit "send"
3.
SUBMIT referral paperwork via:
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