How do you want to send the Insurance details?

I can send a photo of my insurance card / Puedo enviar una foto de mi tarjeta de seguro

I will input my details here / Ingresaré mis detalles aquí

Upload a photo of your Insurance Card

Do you have an Order Form from your physician?

Yes, and I can Upload a photo now / Sí, y puedo Subir una foto ahora

No, but I will send it by text or bring it on the day of the scan / No, pero lo enviaré por mensaje de texto o lo traeré el día del escaneo

Upload your Physician Order Form

*Use this field to send us your Physician Order needed for the scan.

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

I consent to securely uploading my doctor’s recommendation slip and acknowledge that my health information will be processed in compliance with HIPAA regulations.

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