Medical Staff Office Documents & Forms

Common documents and forms provided by the medical staff office or service departments at El Camino Health.


If you don't see a document you need please contact the Medical Staff Office directly.


Physician Forms

Services Referral Forms

  • Imaging Referral and Order Form (PDF)
    Scheduling information, phone and fax numbers are included in this PDF for both Los Gatos and Mountain View locations. Use this form to order the following imaging procedures:
    • Breast Health (biopsy, mammogram, MRI, ultrasound)
    • Bone Density (DEXA, vertebral fracture assessment)
    • CT
    • Diagnostic Imaging/X-Ray
    • Fluoroscopy
    • MRI
    • Nuclear Medicine
    • PET/CT
    • Ultrasound

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