The Breast Cancer Consultation Service Referral Process

To obtain a second opinion from Dr. Lagios, please:

• Print out and complete the three forms provided below:
  
  
  
  • Contract for Services
    
  • Patient History
    
  • Authorization
    
  
  
• Fax the forms to us at: (415) 435-2293  
  

These forms are all provided in Adobe Reader format (pdf), which can be downloaded free of charge from here.

We will take care of ordering your pathology slides and breast imaging. We will also arrange to have these materials sent to us via Federal Express.

Important:  In order to expedite the review (second opinion) of your breast cancer diagnosis, all three forms above must be downloaded, printed out, filled out completely, and faxed to us!



If you are a physician requesting a second opinion for your patient or a pathologist requesting a second opinion on a case, please call our office to obtain our street address for Federal Express/UPS deliveries and to advise us of your request:

 
(415) 789-0965