Scheduling

Fort Wayne, IN (877) 422-1491   |   Auburn, IN (800) 441-6736   |   Decatur, IN (866) 441-6736


Scheduling

(Community Open MRI)

To verify in-network coverage or checking on a pre-cert, please use our TAX ID # 270047693.

Note: Pre-certs/Prior authorizations are handled through MedSolutions (888) 693-3211 on the following insurance companies: AETNA, CIGNA, Great West, NGS America, and Coventry.

There are three ways to schedule an appointment:

  1. Phone: Call the desired MRI center location and schedule over the phone
     
  2. Fax:  Print out a copy of the Rapid Scheduling Form, Fill in the information, and Fax it to the desired location:

    Print Rapid Scheduling Form

                Fort Wayne Open MRI:  Fax (260) 423-1421
                Auburn Open MRI:  Fax (260) 925-4720
                Decatur Open MRI:  Fax (260) 728-4675
     
  3. Email:  For Electronic Rapid Scheduling please fill out the form below and we will call and schedule patient for you (if not already scheduled).
    We will let you know ASAP if a pre-cert is required. Otherwise, if you have already obtained a pre-cert then please list in the appropriate box below:

  Fields marked with * are mandatory
*  *Person Filling Out Form:
*  Email:
  Patient Name:
  D.O.B.:
  Phone # (Home/Work):
  Cell #:
  Is this an injury/liability?:
  Insurance:
  Insurance phone #:
  Insurance I.D. #:
  Ins Group # if applicable:
  Pre-cert or Prior Auth #:
  MRI study to be performed:
  Reason for Procedure:
  Dr. Office Phone #:
  Dr. Office Fax #:
  Name of Referring Physician:
  Location of Referring Physician:
  Physician's Signature:
  Patient will need copy of:
        
  Comments:

  Schedule Patient at:
           
   

 

 

Print Version Print Version      
Home | Insurance / Costs | Scheduling | MRI Information | About Us | Contact | Our Locations
©2011 Yellow Book USA, Inc. All Rights Reserved | Privacy Policy