Physician Referral

If you have a patient in the Greater Los Angeles area who requires breast cancer screening or mammography at Bedford Breast Center in Beverly Hills, we welcome your referral.

How To Make a Referral

Refer your patient using any of the following methods:

  • Send a fax to (424) 202-3759 
  • Complete our online referral form below: 

Referral for Evaluation and Treatment

Fields marked * are required

Referring Physician Information

Patient Information

Requesting*

Indications*

Select all that apply.

Area(s) of Focus

Select all that apply. Please select your areas of focus using either the provided diagram or the checkboxes below. Click on any of the eight quadrants in the diagram to make your selection(s). The selected area will turn red to indicate your choice.

Physician Notes

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