Physician order forms for outpatient services

When completed, please fax to scheduling at 350-3862.

Order for outpatient laboratory services:

• Via Christi Hospitals in Wichita
• Via Christi Hospital St. Teresa

Order for outpatient ancillary:

• Via Christi Hospitals in Wichita
• Via Christi Hospital St. Teresa

Order for outpatient radiology:

• Via Christi Hospitals in Wichita
• Via Christi Hospital St. Teresa

Outpatient Rehabilitation Scheduling