What Your Ultrasound Order Should Include

Required Information

Patient's full name and date of birth
Patient's contact telephone number
Referring provider's name and practice information
Referring provider's contact information
Requested ultrasound examination and laterality, when applicable
Clinical indication or reason for examination
Referring provider's signature or authenticated electronic order

Additional Helpful Information

Insurance information
ICD-10 diagnosis code
Relevant clinical history
Routine or urgent scheduling priority

Refer a Patient

Simple, convenient ultrasound referrals for healthcare providers.

Alpha Vascular & Ultrasound Center accepts ultrasound orders generated through your practice's existing electronic medical record (EMR) system. There is no need to use a separate referral platform or complete our standardized form if your existing requisition contains the required information.

Fax Your Existing Order

Use your practice's existing ultrasound requisition or EMR-generated order.

Fax: (413) 674-0001

Download Our Referral Form

Don't have a suitable ultrasound order form? Download our standardized requisition, complete it, and fax it to our office.

Download Ultrasound Order Form

Questions About Referring a Patient?

Please contact our office for assistance with examination selection, referral requirements, insurance questions, or appointment scheduling.

Phone

(413) 387-0022

Fax

(413) 674-0001

Address

234 Russell Street, Suite 204, Hadley, MA 01035

Office Hours

Monday: 11:00 AM – 2:00 PM
Tuesday – Friday: 8:00 AM – 4:00 PM
Weekend appointments available by appointment only.

Ultrasound Image Access

Secure access to ultrasound images may be arranged through our OmniPACS imaging system. Referring providers and authorized recipients may contact Alpha Vascular & Ultrasound Center to request access. Access is provided following appropriate verification and authorization.