PATIENT REGISTRATION

ONLY FILL OUT THE FORM BELOW IF YOU NEED A REFERRAL OR DOCTOR'S ORDER FOR SPORTS MEDICINE OR ORTHOPEDIC (MUSCULOSKELETAL) IMAGING.

IF OTHER TYPES OF MEDICAL IMAGING ARE REQUIRED, OR IF YOU ALREADY HAVE A REFERRAL/DOCTOR'S ORDER, PLEASE SEE THE 'HOW IT WORKS' SECTION.