Image Order Form Hours of Operation: 8am - 6pm Monday - Friday Phone: (617) 726-1798 Fax: (617) 724-0264
Note: Signed Release Authorization Forms (1, 2) below are required for ALL Images and Medical Reports released.
----(1) Authorization to Release Images - Download pdf
----(2) Authorization to Release Medical Report and Images to Third Parties- Download pdf
For mailed images/films/reports, please FAX authorization forms to 617-724-0264
Please print your confirmation and use the Reference Number when calling for information regarding your order.
For Mammogram orders, unless otherwise requested by your physician, we will send images from two previous exams in addition to the films from your most recent