Our ProceduresOur StaffScheduling an AppointmentDownload Pre-Registration FormsBilling InformationDirectionsContact


DOWNLOAD PRE-REGISTRATION FORMS

To download any of the forms, simply click on the links below.

Accident Information (PDF)
Authorization for Use/Release of Health information (PDF)
Authorization of Release of Information to Family and/or Friends (PDF)
Financial Arrangement Form (PDF)
Insurance Verification (PDF)
Medicaid Denial (PDF)
Patient Information Sheet (PDF)
Privacy Practices (PDF)
Visitor Information (PDF)
Worker’s Compensation / On-the-Job Accident (PDF)

Download Adobe PDF Reader


Our Procedures | Our Staff | Scheduling an Appointment | Download Pre-Registration Forms | Billing Information | Directions | Contact
Copyright 2015, ALL RIGHTS RESERVED - Dalton Imaging Center - 1502 N. Thorton Avenue - P.O. Box 1207 - Dalton, GA 30722 - 706-278-9729

 

Site Meter