Refer a patient

Structured referral request form

Three short steps. This form collects only administrative information about the sender. It does not request patient data, diagnoses, records or sensitive clinical information.

Step 1Who refers
Step 2Request type
Step 3Consent and submission

Step 1 of 3 — Details of the professional or institution sending the request.

Do not send photographs, records or sensitive medical information through this form. This channel does not handle emergencies.

Name of the referring professional or institution*

Name of the person or organization making the referral.

Organization or institution*

Name of the organization or institution, if applicable.

Who are you?*

Indicate your role or function within the organization.

We will only use this email to respond to your request.

Phone

Include the area code.

Leave this field empty

If this is an emergency, call 911

If there is bleeding that will not stop, high fever, severe pain, strong odor, rapidly spreading redness, or loss of consciousness, seek emergency care immediately. This site does not handle emergencies and does not replace medical care.

911

Medical notice

The information presented on this platform is for educational and informational purposes. It does not constitute diagnosis, treatment or medical advice and does not replace an evaluation by a licensed healthcare professional.

The physician and the treating team retain responsibility for clinical decisions. AOR Medical Solutions of Puerto Rico supports coordination, education, technology and continuity of the process.