(415) 837-5990

Refer A Patient For Chiropractic Imaging

Please fill out the referral form below and we will contact the patient to schedule an appointment.

You can also download a copy of our referral form here and submit it to info@revealdiagnostics.com

DOB (Patient Date of Birth)
Next appointment Date
Bill Doctor for Scan (Patient charged unless Bill Doctor is checked)

CBCT IMAGING
Upper Cervical (24 x 19cm)

Articular
Orthogonal

DELIVERY

Online
DICOMS only
Print
Jpeg
CD


Rush (4 hour + $50)
Rush (1 hour + $150)
Radiologist Review (4 day return)
Rush (Radiologist 1 day with rush + $30)

Send digital copy to another doctor



Please fill out the referral form below and we will contact the patient to schedule an appointment.

You can also download a copy of our referral form here and submit it to info@revealdiagnostics.com

DOB (Patient Date of Birth)
Next appointment Date
Bill Doctor for Scan (Patient charged unless Bill Doctor is checked)

CBCT IMAGING
Upper Cervical (24 x 19cm)

Articular
Orthogonal

DELIVERY

Online
DICOMS only


Print
Jpeg
CD
Rush (4 hour + $50)
Rush (1 hour + $150)
Radiologist Review (4 day return)
Rush (Radiologist 1 day with rush + $30)

Send digital copy to another doctor




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