Referrals - Harvard Cardiovascular

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'.

First Last

Cell Phone of Referring Doctor

Send automated updates to a patient's referring doctor and improve communication and relationships.

Cell Phone Where Pass Should Be Sent(Required)

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.