Forms

  • ARS Personal History
    1. Patient’s Personal Information with Past and Present Medical History and Insurance Providers
  • ARS Info Packet
    1. Instructions on sending films and Information about our service
  • Attachment A
    1. X-Ray Assignment Agreement with Signature Requirement
      (Page 1 of ARS Personal History Form)
  • Attachment B
    1. Required Form for Insurance Billing
      (Page 2 of ARS Personal History Form)
  • Sample Report 1
    1. Example of professionally written transcribed report