Home Patients Physicians Insurance Providers Forms Careers Locations Contact Us

:PET/CT Basics :Applications :Medicare Coverage :Scheduling :

Schedule an Appointment

Referring Physician's Office

The following information is necessary when scheduling an appointment with our out-patient imaging centers.

• Referring Physician's Full Name
• Referring Physician's Telephone Number
• Patient's Full Name
• Patient's Date of Birth
• Patient's Social Security Number
• Patient's Daytime Telephone Number
• Insurance Carrier
• Authorization Number
• Procedure to be Scheduled
• Diagnosis

Upon scheduling your patient with one of our out-patient imaging centers, please fax the following items to the appropriate office from the list below:

• Patient Demographic information (Patient Registration Form)
• Patient's Insurance Card(s) - (front and back)
• Patient's signed Medical Release Form
• Medical Reports (i.e. CT, PET, CXR, CEA Level, Pathology Report)
• Physician's Prescription (orders)

Copyright © 2010 National PET Scan - Management, LLC. All rights reserved.