Welcome to the online Request an Appointment page for Worknet!

To refer a patient to OIP for an appointment, please complete the form below or call our Appointment Scheduling Department at (717) 761-5530, ext. 1.

This page should only be used by Worknet employees/providers. If you are a referring provider not associated with Worknet and need to request an Appointment or MRI, please visit the For Referring Providers Request an Appointment or Request an MRI page.

Referring Provider Information

Worknet Referring Provider Name *

E-mail Address (optional)

Phone Number *

Fax *

Patient Information

First Name *

M.I.

Last Name, with suffix *

Phone Number *

Birth Date *

Insurance Company Name *

Injury Date *

Injured Body Part *

Where any tests performed? (please mention)

Scheduling Type *

Reason For Appointment *

Will this patient need an interpreter? *

If an interpreter is needed, which language?

Comments

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Click "Submit" to process your 'Request an Appointment' Form.

After-Hours Orthopedic Assistance

Welcome to the online Request an Appointment page for Worknet!

Referring Provider Information

Patient Information