OnlineForms

At Palms Imaging Center we strive to make each patient's visit and every physician's referral as comfortable and convenient as possible. Our online resources are just one of the ways we make this happen.

Click on the links below to open and download our forms. The forms are Adobe .PDF format, which open in Adobe Reader - a free download from Adobe if you do not already have it on your computer.

Physician Referral Form
(download form)

Print this form to fill it out and then return it to us by faxing it to the number on the form.

Patient Registration Form
(download form)

Print this form and fill it out. Once completed, the form can be mailed or faxed to Palms Imaging Center or the patient can bring it on the day of his or her exam.


Patient History Form
(download form)

Print this form, fill it out and bring it with you to your appointment.


Insurance Liability Form
(download form)

Print this form, fill it out and bring it with you to your appointment.