Get Touchstone Imaging Order Form

Filling out the Touchstone Imaging Order Form online is a straightforward process designed to ensure that all necessary information is collected effectively. This guide will provide you with step-by-step instructions to help you complete the form with ease and accuracy.

Follow the steps to fill out the Touchstone Imaging Order Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the scheduled appointment details, including the date and time. This section is essential for coordinating your imaging service.
3. Select the Touchstone Imaging location that you wish to visit by checking the corresponding box next to the location name.
4. Fill in the patient information section. Include the patient's name, date of birth, home phone number, and an alternate phone number for contact.
5. Specify the insurance provider and their identification number. If pre-authorization has been obtained, include the insurance authorization number as well.
6. Provide the name and contact details of the ordering physician. Make sure to sign and date the form in the designated spaces.
7. Indicate any specific imaging requests, including MRI/MRA, CT/CTA, Ultrasound, or X-Ray, along with relevant diagnosis and instructions.
8. Check any additional boxes that apply, such as requests for status hold, results delivery methods, or special instructions.
9. Review all entered information for accuracy and completeness to avoid any issues during the imaging appointment.
10. Once you have completed the form, you can save the changes, download a copy for your records, print it, or share it as necessary.

Complete your Touchstone Imaging Order Form online today for a seamless imaging experience.