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
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)