Refer Your Patient

Mojave Radiation Oncology Center

Location & Appointment Phone Number


18280 Siskiyou Road
Apple Valley, California 92307
Tel: 760.242.9999
Fax: 760.242.1121

Refer Your Patient

How to Refer Patients

To refer a patient to Mojave Cancer Center, please call us at (760) 242-9999. You can also download and complete our Patient Referral Form, then fax it to us at (760) 242-1121. Once we receive your form, we will call your patient and schedule an appointment with Dr. Alqaisi. We will keep you informed of your patient’s reason for treatment and progress. Thank you in advance for your patient referral!

Patient Referral Form:
25kb

We appreciate it if you can fax us the following information prior to your referred patient's appointment:

  • Consultation notes
  • Lab and pathology reports
  • XRAY and scan reports
  • Radiology reports and images (bring either the CD or film)
  • Any prior radiation records (if applicable)
  • Treatment records: Chemotherapy; Radiation
  • Operative reports
  • Hospital discharge summaries
  • Copy of your patient's insurance card, front and back
Vicura Oncology LLC Mojave Radiation Oncology Center Orange County Radiation Oncology Center San Bernardino Cancer Center Atlas Medical Physics Rad Onc Vicura Oncology LLC Mojave Radiation Oncology Center Orange County Radiation Oncology Center San Bernardino Cancer Center Atlas Medical Physics Rad Onc
Home Team About Technology News Affiliations Links Insurance
Treatment Procedures FAQ Patients | Forms Physicians Location Contact Site Map
 
Mojave Radiation Oncology Center, 18280 Siskiyou Road, Apple Valley, California 92307
Tel: 760.242.9999   Fax: 760.242.1121