Here you may create a referral that will be sent directly to our staff for processing. Please note the required fields with an asterisk (*) as we need that information to process your referral expeditiously. Thank you for choosing Orchid Medical, we appreciate your business.
  • 1. Requestor

  • 2. Patient

  • MM slash DD slash YYYY
  • 3. Physician

  • 4. Claim

  • MM slash DD slash YYYY
  • 5. Urinary Drug Testing (UDT) Instructions

  • Please fax any additional documentation to 407-657-2344 or you can attach it directly to this online order.
  • **If you have multiple attachments for this file, please mail them directly to our staff at [email protected]
    Max. file size: 50 MB.
  • 6. Prescription Drug Information for UDT

  • Prescription Drug NameDosageFrequency