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Download Patient Referral Forms
180 Medical offers downloadable catheter and ostomy referral forms to securely refer your patients by fax or email.
Catheter Referral Form
For patients who need intermittent catheters and urological supplies.
Ostomy Referral Form
For patients with colostomy, urostomy, or ileostomy supply needs.
How to Submit Your Referral Form to 180 Medical
Complete the appropriate referral form and then securely send it to 180 Medical by:
Fax: (888) 718-0633
Email: referrals@180medical.com
What information should be included with the referral form?
To help us process your patient referral, include your patient's contact information, insurance information, and any supporting medical documentation in addition to the above standard written order (SWO) form.
We'll follow up within one business day to confirm receipt.
Did you know you can refer patients securely online?
E-Script offers a secure, HIPAA-compliant way to submit your catheter and ostomy referrals online without faxing or filling out paper forms.
With E-Script, you can:
- Manage renewals
- Access order information
- Save e-signatures for easier ordering and renewals
- Track your patient's first shipment
Plus, we offer a Quick Referral option when you're short on time and need to quickly submit a referral without logging in.
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