Online Doctor Referral Form
You may refer patients to our office by filling out our secure online Referral Form below. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it. You may submit your x-rays electronically by emailing them to us. If you are referring to the Kenmore or Mill Creek office, please email the x-rays to xrayskenmore@ipanw.com. For the Tri-Cities, email them to xraystricities@ipanw.com. We hope you find this a convenient tool for referring your patients.
Technical Note:
PC Users
Our online form uses Adobe Acrobat Reader 9 or greater plug-in to conveniently submit the form from home or work. Please download the free plug-in from Adobe's web site if it is not already installed on your system. It is important that you have at least version 9 of the plug-in to successfully use our online form.
Mac Users
You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe's web site.
