Perinatal Diagnostic Center Ultrasound & Genetic Counseling Order Form

 

* Select a PDC Office Location:

 

* Required

Required Patient Information

Ultrasounds & Procedures
Antepartum Testing

(NST only done in Palo Alto)

Consults
Indications (Required) – Check all that apply

 

* Check the following for this pregnancy:

Referring Provider
Insurance Information
Document Upload

Please attach the following documents:

  • All relevant clinical documents (i.e. clinic notes, history and progress notes, medication history, growth charts-height and weight, head circumference, labs, diagnostic reports and a copy of the insurance card)
  • Facesheet with demographics
  • A copy of insurance card
  • All prenatal records (if referring to the Modesto, Salinas, or Santa Cruz practices)

Upload File (up to 30 files):


Attached Files
    Directions & Maps
    Perinatal Diagnostic Center – Palo Alto
    Perinatal Diagnostic Center – Palo Alto

    725 Welch Road

    Suite 391

    Palo Alto, CA 94304

    Maps, Directions & Parking

    3rd Floor

    See a detailed map and guide to our clinics in English (PDF).

    Genetic Counseling: (650) 723-5198

    Phone: (855) 485-3357

    Fax: (650) 725-9877

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: 8 a.m. - 5 p.m.
    • Wed: 8 a.m. - 5 p.m.
    • Thu: 8 a.m. - 5 p.m.
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed
    Perinatal Diagnostic Center – Redwood City
    Perinatal Diagnostic Center – Redwood City

    2900 Whipple Avenue

    Redwood City, CA 94062

    Maps, Directions & Parking

    Suite 240

    See a detailed map and guide to our clinics in English (PDF).

    Phone: (650) 381-3480

    Fax: (650) 381-3488

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: 8 a.m. - 5 p.m.
    • Wed: 8 a.m. - 5 p.m.
    • Thu: Closed
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed
    Perinatal Diagnostic Center – Fremont
    Perinatal Diagnostic Center – Fremont

    2147 Mowry Avenue

    Fremont, CA 94538

    Maps, Directions & Parking

    Suite C6

    See a detailed map and guide to our clinics in English (PDF).

    Note:

    Tues: closed for patient care, administrative services only

    Phone: (510) 713-9994

    Fax: (510) 713-9997

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: Closed
    • Wed: 8 a.m. - 5 p.m.
    • Thu: 8 a.m. - 5 p.m.
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed
    Perinatal Diagnostic Center – Salinas
    Perinatal Diagnostic Center – Salinas

    212 San Jose Street

    Salinas, CA 93901

    Maps, Directions & Parking

    Suite 311

    See a detailed map and guide to our clinics in English (PDF).

    Phone: (831) 440-3441

    Fax: (831) 440-3432

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: 8 a.m. - 5 p.m.
    • Wed: 8 a.m. - 5 p.m.
    • Thu: 8 a.m. - 5 p.m.
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed
    Perinatal Diagnostic Center – Santa Cruz
    Perinatal Diagnostic Center – Santa Cruz

    1685 Commercial Way

    Ste A

    Santa Cruz, CA 95065

    Maps, Directions & Parking

    See a detailed map and guide to our clinics in English (PDF).

    Phone: (831) 464-9994

    Fax: (831) 464-9996

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: 8 a.m. - 5 p.m.
    • Wed: 8 a.m. - 5 p.m.
    • Thu: 8 a.m. - 5 p.m.
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed
    Perinatal Diagnostic Center – Modesto
    Perinatal Diagnostic Center – Modesto

    200 E Granger Ave

    Modesto, CA 95350

    Maps, Directions & Parking

    See a detailed map and guide to our clinics in English (PDF).

    Phone: (209) 672-6377

    Fax: (209) 672-6378

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: 8 a.m. - 5 p.m.
    • Wed: 8 a.m. - 5 p.m.
    • Thu: 8 a.m. - 5 p.m.
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed