Nationwide Access To Affordable Imaging
Referral Form Downloads
Wanting to refer a patient?
To refer a patient to our program, you can download a referral form below. Referrals can be sent to our scheduling fax at 855-345-5222. Prefer using a referral pad? Please contact us to request a referral pad and we will be happy to send you as many as you need at no cost.
Specialized Imaging Order Forms
Contact Us
Radiology Assist Program 2100 Valley View Ln, Suite #490, Farmers Branch, TX 75234
Phone | : (855) 346-5152 |
Fax | : (855) 345-5222 |
Hours : Mon-Fri 8-5pm (CST) More Contact Information »