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Patient History Form – Abdominal


    Referring Doctor


  • 6 radiographs max

  • Additional fee applies

  • Must be sent in dicom format to our server

  • Radiographs older than 2 weeks will not be accepted

  • If you anticipate your patient needing fine needle aspirates, please obtain consent prior to scan, as well as permission to sedate if needed.

    When you submit this form, you will be emailed a copy of the information you submitted. You can print that email for your records.