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 SureHow long ago did you receive your MRI?* 0 to 6 months 6 months to 1 year 1 to 2 years 2 years or moreWhere is your MRI report?* I have physical copy My Imaging Center has it on file I’m not sureName 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 UnknownWho 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 EveningAdditional Comments or Questions?
