Fax all requests to 801-618-0920
We will contact the patient for you to schedule an appointment
Fax Your Own Form
Fax: 801-618-0920
Please make sure to include:
1. The reason for the study
2. Patient demographic info
3. Patient insurance info
4. Return fax number
5. Physician signature
Call for Instructions
If you have specific questions not answered on this website, please call 801-871-5228