Step 1: MRI Specifications & DetailsWhat type of MRI do you have?* Cervical (neck) region Thoracic (mid-spine) region Lumbar (lower back) region Shoulders or Arms Hip, Buttocks, or Legs Joints (wrists, elbows, knees, ankles, etc.) Not Sure How long ago did you receive your MRI?* 0 to 6 months 6 months to 1 year 1 to 2 years 2 years or more Where is your MRI report?* I have physical copy My Imaging Center has it on file I’m not sure Name of the facility where the MRI was taken* Step 2: Health Insurance InformationSelect your primary state coverage.*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWhat type of insurance do you have?* Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO) Health Maintenance Organization (HMO) Personal Injury Protection (PIP) Worker's Compensation Medicare Medicaid Self Pay Other or Unknown Who is your primary insurance carrier?* Step 3: Get Your ReviewFirst Name* Last Name* Email* Phone Number*Best Time to Contact You As soon as possible Morning Afternoon Evening Additional Comments or Questions?
