Referral Forms

Please choose from the following two ways to refer patients to RGV OMS. 

Referral Form (Brief)
Editable PDF which can be emailed or faxed to us, and/or can be printed and given to the patient.

Electronic Referral (Detailed)
Fill out a form online that can submitted directly to our EMR system.  This form allows for more detailed input if desired, like insurance
information, the patient’s medical history, and more. 

Thank You!