Please complete the appropriate forms below and bring to your scheduled appointment along with your insurance card(s).
Patient Information Form (Registration Form) - To be completed by all New Patients.
Financial Policy - To be completed by New and Current Patients.
CT Patient History Form - To be completed by all patients scheduled for a CT scan.
MR Patient History & Screening Form - To be completed by all patients scheduled for an MRI Scan.
Physician or Provider Order Form - To be completed by referring MD/provider only (not for patient use). Please send this form with the patient after appointment has been scheduled or fax completed form to (901) 680-1902 for DI to schedule appointment.