REFERRAL Forms

---

Referral Forms

To ensure the highest standard of clinical care and diagnostic accuracy, all diagnostic imaging procedures require a formal Physician Referral Form. This document serves as a medical prescription, detailing the specific type of scan required and the clinical indications for the study.

For your convenience, completed and signed referral forms can be submitted using any of the following methods:

• Online Upload: Attach your digital file directly to the "Attachment" section of our Online Patient Questionnaire.
• Email: Send a scanned copy or clear photo of the form to our administrative team at info@omsimaging.com or fax to 972-972-8480

[!IMPORTANT] Please Note: To comply with healthcare regulations, your referral form must be signed by a licensed physician before your imaging session can begin.