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A form for physicians to print out and fax.
The Sharp Outpatient Pavilion offers the following Imaging Services Requisition Form to physicians and health care practitioners to print out and fax in. Please note that all bolded areas must be completed to perform exams. Once the form is complete, please fax it to 858-939-5076.
You will need Adobe Acrobat Reader to view and download this file. Please note that Sharp HealthCare does not control or endorse the information presented on external websites, nor do these websites endorse the information found on www.sharp.com.
1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm.
If you have any additional questions,
send us an email using our secure contact form.
Sharp HealthCare is San Diego's health care leader with 7 hospitals and 2,600 affiliated doctors.
Sharp is not-for-profit and relies on fundraising. © 2013 Sharp HealthCare. All rights reserved.