Medical Second Opinion Request Form

The Medical Second Opinion Request Form is designed for specialist practices, academic medical centers, and telemedicine platforms that offer independent diagnostic and treatment plan reviews for patients seeking a second opinion. This second opinion request form streamlines the intake process for what is often a complex, document-heavy consultation by collecting the patient's current diagnosis, treating physician information, proposed or ongoing treatment plan, and the specific questions or concerns driving the request for an additional medical perspective.

This medical second opinion form includes a robust medical records upload section where patients can attach pathology reports, imaging studies (MRI, CT, X-ray), lab results, operative notes, biopsy reports, genetic test results, and treatment summaries from their current provider. The structured format ensures the reviewing physician receives all relevant clinical documentation before the consultation, enabling a thorough and efficient review. The insurance information field supports verification of second opinion coverage, which many insurance plans include as a benefit, particularly for surgical recommendations, cancer diagnoses, and other serious conditions.

The integrated appointment booking field allows patients to schedule their second opinion consultation directly through the form, whether in-person or via telehealth, reducing administrative back-and-forth. A consent agreement authorizes the release and review of medical records and establishes the scope of the second opinion engagement. This form is invaluable for oncology practices, neurosurgery centers, orthopedic surgery groups, and any specialist office that regularly receives patients seeking confirmation or alternative perspectives on significant medical decisions.