Get X-ray And Bone Density Requisition - Health Services For ... 2020-2026

The X-Ray And Bone Density Requisition form is a crucial document used to request diagnostic imaging services. This guide provides step-by-step instructions on how to effectively complete the form online, ensuring all necessary information is provided accurately.

Follow the steps to fill out the requisition form accurately and efficiently.

1. Click ‘Get Form’ button to access the X-Ray and Bone Density Requisition form and open it in your document editor.
2. Begin by entering your name in the designated field. Please include your full name as it appears on your health card.
3. Next, input your gender, choosing either M for male or F for female.
4. Provide your address in the specified fields to ensure accurate contact information is recorded.
5. Enter your phone numbers, including a home and work number where applicable, in the appropriate areas.
6. Fill in your date of birth (D.O.B.) and health card number. This information is essential for identification purposes.
7. Indicate your unit number if relevant, or leave this blank if not applicable.
8. Specify the preferred appointment day, date, and time by filling out the respective fields clearly.
9. Select your appointment location by checking the respective box for Georgetown, Milton, or Oakville site.
10. If you agree to receive test information via your home telephone, provide that phone number as instructed.
11. Complete the clinical notes section for any relevant medical history or details required for your imaging.
12. Indicate the specific x-ray requests by checking the appropriate boxes under the relevant categories, such as abdomen, head & neck, or others.
13. For any bone density tests, indicate your risk status and whether you want a copy of the report sent elsewhere.
14. Lastly, the referring physician must sign the form and provide their contact information, including the location and date of referral.
15. Review all entries carefully for accuracy. Once completed, you can save your changes, download the form, print it, or share it as needed.

Complete your X-Ray And Bone Density Requisition form online today to ensure a smooth appointment process.