Free MRI and CT Scan Review

Spine Associates offers a comprehensive review of MRI studies or MRI reports to prospective patients at no obligation to the patient. Dr. Francis will review your MRI scan and note each condition, its cause and severity. Dr. Francis’ assistant will contact you to discuss the findings. Dr. Francis is a fellowship-trained, board-certified spine surgeon and has extensive experience treating the spine. Spine Associates offers accurate diagnosis and advanced treatment for a variety of spinal conditions.

MRI/CT REVIEW SUBMISSION FORM

Free MRI/CT Review Submission Form

First Name *

Last Name *

Email Address *

_______________________________________________________________________

Gender

Date of Birth (You must be 18 years of age or older to submit.) *

Month*

Single Line Text *

Day*

Single Line Text *

Year*

City

State

Zip Code

How can we help?

Insurance Insurance

Phone Number

Preferred Contact Method

Phone

Email

OtherOther

By filling out the MRI Request form you acknowledge and agree:

That your personally identifiable health care information can be shared with employees Spine Associates
That the MRI review is providing only an informational review of the documents that you are providing.
That the information provided by Dr. Francis is not a form of diagnosis. A diagnosis can only be made if you have been physically examined by Dr. Francis

Spine Associates acknowledges and agrees:

Upon receipt of the MRI Submission form it will not share your personally identifiable health care information to third parties without your written consent.

Send your MRI Studies to the address listed below:

Spine Associates
9301 Southwest Freeway
Suite 600

Attn: Dr. Francis - MRI Review

Phone: (713) 383-7100
Fax: (713) 383-7500

To insure that we can track your MRI Review Submission properly, please be sure to include your name, mailing address and telephone number.

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