Uic oral surgery referral 2025

1. Click ‘Get Form’ to open the uic oral surgery referral in the editor.
2. Begin by entering the 'Date of Referral' at the top of the form. This helps track when the referral was made.
3. Fill in the 'Referring Practice/Provider' section, including practice name, doctor's name, phone number, and email. Accurate contact information ensures smooth communication.
4. Next, provide 'Patient Information.' Enter the patient's name, date of birth, gender, and if applicable, details for a parent or guardian.
5. Complete the 'Home Address' section with street address, city, state, and ZIP code. Include a phone number and email for the patient as well.
6. Indicate the 'Insurance Plan/Provider' to facilitate billing processes.
7. Specify how long the patient has been with your practice to give context to their care history.
8. In the 'Reason(s) for referral' section, check all applicable options that describe why you are referring this patient.
9. If available, attach any relevant documents such as photos or X-rays using our platform's upload feature.
10. Finally, provide any additional comments in the designated area to assist in understanding the patient's needs better.

Start filling out your uic oral surgery referral form online for free today!