X-Ray Patient History Form Thank You

Thank You from Jericho Specialty ImagingThank you for filling out our X-Ray Patient History form.

Did you fill out our X-Ray Patient General Information Form and X-Ray Consent Form (2 additional forms)? X-Ray patients need to fill out these two forms as well.

Click here to complete the X-Ray Patient General Information Form.

Click Here to complete the X-Ray Consent Form.

Filling out these three forms will ensure a speedy visit with us for your X-Ray exam.

We look forward to seeing you in the office.


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