If you need a blank referral slips:

Right click on the image of the blank referral slip, open image in New Tab

In new tab, Ctrl-P to Print
- Layout = Landscape
- you many have to adjust the scale to fit on 1 page depending on your settings

Please complete (including referring Dr name and phone number) and either email or fax us a copy and/or have the patient bring the referral to their appointment.

Fax: (458) 658-8088
eMail: foothillendo@gmail.com

Let us know if you would like a referral pad, we would be happy to drop one off or mail one to you.

Thank You!