ECHO Ultrasound Referral

If you're here - you probably had an ultrasound at ECHO Ultrasound in Utah.

I'm sorry if you have received an abnormal result. I have been there - literally - myself.

I know that it can cause some anxiety and uncertainty. I wanted to offer women who DO NOT ALREADY HAVE A PROVIDER a way to get a quick referral for further imaging.

If you already have a provider I ask that you please utilize them for your referral for future care.

This referral from Natural Health NP LLC is for efficiency and as an in-between-place-holder until you can find an in-person Primary Care Provider or OB/Gyn provider to establish care with. Unfortunately, as a telehealth/virtual provider I will not be accepting responsibility of the results from ECHO or the results of the future imaging.

I am providing this service to get the necessary steps going, while you are establishing care with an in-person provider.

I do not already have a Primary Care Physician or OB/Gyn through which I can get a referral from.
I understand that Natural Health NP, LLC/Miriam Hughes are sending this referral on my behalf, but a long-term provider-patient relationship is NOT being formed because of this referral.
I agree that Natural Health NP, LLC/Miriam Hughes is not accepting responsibility for diagnosing, managing, or treating the results from ECHO ultrasound and/or the future imaging results received as a result of this referral.
I fully understand that this referral is only to move forward the steps necessary to get the next recommended imaging, biopsy, etc.
I agree that I will not be under the direct care of Natural Health NP, LLC/Miriam Hughes for the results from ECHO ultrasound and/or future results.
I understand that there is a nominal fee of $25 to Natural Health NP, LLC for sending this referral.
I agree that Natural Health NP, LLC/Miriam Hughes will not accept ANY insurance payment for sending this referral. I am required to pay this fee in "cash" (debit or credit card) and my insurance will NOT be billed for the $25 fee.
I agree that I will not seek insurance reimbursement for the $25 fee on my own.

If you would like to have Natural Health NP, LLC send a referral on your behalf - you need to be able to answer "YES" to the following questions:

If you were able to answer "YES" to all of the previous questions and still would like Natural Health NP, LLC to send a referral on your behalf, please fill out the form below.

Please do not include detailed health information in the form below. Just basic answers are fine, we will get more information during our appointment.

Please include 3 preferred dates/times for your appointment in the message.