Interpretation of Your Films:
- Consent and Billing Formcompleted by patient and/or your office staff.
- Interpretation Request Formcompleted by doctor.
- Place films, Consent and Billing Form, and Interpretation Request into mailing jacket and place into mail. Or films may be mailed, then fax Consent and Interpretation Request Forms to us.
- Your patient or insurance will be billed. Service charges must be paid within 45 days from date of service.
Performing Examination on Your Patient:
- Examination Request Form completed by doctor.
- Fax or mail Examination Request Form to us.
- We will call patient to schedule, or the patient may call us at your discretion.
- Examination performed. Please verify your female patient is not currently pregnant or attempting pregnancy.
- Films and jacket hand-carried by patient or mailed back to referring doctor.
- Your office will be billed. Service charges must be paid within 30 days of date of service.
The following forms and useful documents are in Adobe Acrobat; they require the free Acrobat Reader to view. Click on each to download and view.
Informed Consent and Billing Form
Your privacy is important to us. All information received in the above forms and through other communications is subject to our Patient Privacy Policy.