Referral Slips/Order Forms
Here is our referral slip in a PDF format. To view this file you must have Adobe Acrobat installed on your computer. If you don’t, you can download ACROBAT READER for free.
Scheduling & Pre-Authorization Fax Request Form
Use this combination form if you prefer to have RDC contact your patient to schedule an appointment and obtain authorization for the exam. No additional referral slip is necessary if the physician signs the bottom of this form.
NOPR PET Forms
Medicare insurance who are in need of a PET Sodium Fluoride Bone Scan, please submit the attached .pdf with the patients referral. RDC can assist with helping to have the NOPR cover the cost of this exam.