Radiology Report RX Order Form

Please complete the entire form below. All fields indicated by * are required. Report per scan cost $125.

Before you begin, please review the Scan Quality tips. You will also need to have the scan of your patient ready in order to process your case.

Scan Quality:

Before submitting your case, check that all your scans adhere to the following guidelines:

  • Scan field of view: Make sure no part of the desired arch to be treatment planned is cut off, there is no patient movement and a scan appliance was used.
  • Scan resolution: Minimum of 0.3 voxel is recommended. The smaller the number, the better (ex: 0.2, 0.1, etc.).
  • Scan format: Please send all files in DICOM format.

Please be specific if multiple locations exist.
If you are an existing customer, you can skip this.

Order Information