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Medical Imaging News
Trident Wins Best Medical Practice in Gwinnett Magazine’s Best of Gwinnett”
TMI first in Georgia to provide new imaging test to identify early Alzheimer’s disease
Trident Named Exclusive Georgia Provider of New Blood Test to Detect Cancer
Affordable Mammograms at Trident Medial Imaging Clinics (video)
Patients Save Thousands by Having MRI, CT and Other Scans Performed at Outpatient Imaging Centers
Physician's Appointment Request
NOTE:
- For all STAT studies, please contact office to schedule
- This is an appointment request only. Trident staff will confirm appointments with the patient.
Physician Info
Doctor's Name
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Office Phone #
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Office Contact
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Office Email
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Patient Info
First Name
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Last Name
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Date of Birth
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Phone #
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Secondary #
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Email
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Primary Insurance
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Primary Ins. #
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Secondary Insurance
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Secondary Ins. #
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Order
ICD-9 Code
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Primary Diagnosis
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Type Of Scan
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Cardiac PET
CT
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X-Ray
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Body Part
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Trident Location
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Requested Date
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Requested Time
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8:00 am
9:00 am
10:00 am
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12:00 pm
1:00 pm
2:00 pm
3:00 pm
4:00 pm
5:00 pm
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By entering my initials in the box below I am confirming that I am the doctor noted above and I am electronically signing this medical procedure order for the stated patient.
Electronic Signature
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