Please submit this form to create a digital ‘pass’ for a new referral source. The pass contains Dr. Khandelwal’s information; when the pass is shown to a patient, and a patient scans the QR code, they will immediately be directed to book an appointment online.

New Digital Pass (Dr. Manoj Khandelwal)

Name of Referring Doctor(Required)
Track who is sending patients. Think of this as a modern-day 'script'.
Send automated updates to a patient's referring doctor and improve communication and relationships.
You may want to send the pass to yourself first, or you may want to share the pass with the office staff of the referring doctor.

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