The following forms are used in our facility to enable us to properly perform your examination and provide your insurance company with the information needed to process the claim.
We know no one likes to fill out endless paperwork, the information we gather is the minimum necessary to proceed with your examination. These forms can be printed and filled out before arriving at the office to save time. If you do not have a printer the forms will be available for you to fill out upon arrival at our facility.
- Patient Demographic Form (For ALL patients)
- Patient Information Form (For ALL patients)
- Patient Financial Responsibility form (For ALL patients)
- HIPAA Omnibus Notice of Privacy Practices
The following forms are available at our clinics at the time of your appointment:
- Nuclear Medicine form (Nuclear Medicine patients only)
- Thyroid Uptake & Scan Form (Only Nuclear Medicine patients having a thyroid uptake scan)
- MRI forms with MRI low cost (MRI patients only)
- CT forms (CT patients only)
- X-Ray form (X-Ray patients only)
- PET forms (Page 3 only for patients having diagnostic CT with a PET scan)
- Mammography forms (Mammography patients only)
Sun Radiology accepts most health plans. Co-pay, if one is required, will be paid at the time of your visit. We also accept Workman’s Compensation and liens. If you do not have insurance at this time or wish to self-pay for your examination call our office for a cash pay schedule. Payment plans may be available.
If you have any questions regarding pre-authorization requirements or insurance plans that we accept please feel free to ask at the time of scheduling.