Providence Diagnostic Imaging Referral Forms

Providence Diagnostic Imaging provides high-quality medical imaging services by ensuring the highest standard of patient care and excellence in performance, interpretation and delivery of cost-effective imaging services.

Our departments are recognized as leaders in Oregon for service delivery, exceptional staff, specialized radiology expertise and ease of access.

Referral Forms

• Diagnostic Imaging Outpatient Order Form (for external providers)
• Lung Cancer Screening Patient referral form - Portland/Hood River/Seaside
  Providers please use this form when referring patients to Providence Lung Cancer Screening Program in Portland, Hood River or Seaside.
• Lung Cancer Screening Patient referral form - Southern Oregon
  Providers please use this form when referring patients to Providence Lung Cancer Screening Program in the Southern Oregon area.