Referral Instructions & Requirements

Need to refer a patient?

  • Click here to download a patient order that may either be given to the patient or faxed directly to our office. Patients may schedule themselves for an appointment; however, to assure a smooth scheduling process it is best to receive an order/referral before the patient calls.

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  • Contact our scheduling specialists at 360-493-4646
  • Fax to referrals to 360-493-5326

Need new Referral Forms? Call (360) 493-4600 to submit a request.

SSR can accommodate same day appointments in most modalities. However, some exams require patient preparation or authorizations that may require additional time, making same day appointments difficult or not possible.  If you have questions regarding preapproval or patient preparation, please contact us at 360-493-4600.

SSR also offers walk in appointments for screening mammograms, bone densitometry scans and x-ray. While mammograms do not require a physician order, they do require that patients have a primary clinician to whom the results may be sent. (Note: Appointments must be made for all diagnostic mammograms.)

Referral Requirements:

Patient Information:

  • Name
  • Date of Birth
  • Phone Number
  • Insurance Information/Carrier

Clinical Information:

  • Referring Clinician
  • Exam Type
  • Diagnosis/Presenting symptoms or condition (ICD-9 code, when possible)
  • Location of any prior exams of the same area (for comparison)

Other Information:

  • Would you like the results sent to any other practitioners?
  • Special Instructions?
  • Patient Limitations or Conditions

Important Notes:

It is important for us to know if the patient has had any previous studies performed of the area being evaluated. If there have been previous studies, please fax the reports to 360-493-5326. We will call the imaging site to request the films.

While we are happy to assist with the insurance process whenever possible, it is still the patient’s responsibility to know what exams their insurance will cover and whether their insurance specifies a preferred provider location.