If you have radiographs you would like to include with your referral, please complete the form below.
Radiograph Referral Form: Fillable Radiograph Referral PDF
Follow the appropriate distribution option below:
- Complete, then save as a PDF and email to firstname.lastname@example.org (attach your radiographs to the email)
- Complete, then save as a PDF and email to email@example.com, but send your radiographs to our server > (best for multiple or large films) VSS PACS routing information you will need: AE Title: RAPIDSTORE97035 Host name: rapidstore.vssoc.com Port: 104
- Complete, then save as a PDF. Print out a copy to be delivered in person or mailed to VSSOC along with the radiographs.