Patient Referral for Health Professionals

ALERT BAR

Radiology Referrals

The form and information provided below are for use by physicians, their office representatives and other care providers who wish to refer a patient for RADIOLOGY SERVICES at UTMB. Contact information collected via this form is used expressly to serve our referring physicians and their patients.

If you are a physician and wish to refer a patient for other services at UTMB, you may do so online.

Radiology Outpatient Diagnostic Order Form

Instructions: Please click to access our RADIOLOGY REFERRAL FORM

You may 1) print a blank copy of the form, fill in and fax; or 2) fill the form online, print and fax. Please remember to sign either option and fax to the number of your specific clinic. A UTMB staff member will follow up with you promptly.

Non-UTMB Image Study Upload

To upload and share medical images taken elsewhere to UTMB, use the ImageShare tool

For user tips and instruction on uploading non-UTMB images, access the ImageShare user guide