TESTIMONIALS
"Everyone was great. Very fast and very convenient, thanks. Very professional. I will come back next year."
Oro Valley, AZ
"I will recommend this to my friends. Thank you so much for all you do. Thanks for making getting a mammogram so convenient."
Phoenix, AZ
The following forms have been provided for your convenience. Please note that these forms may not be the appropriate forms for all patients in all circumstances.
New patients can save time during their first appointment by completing the forms prior to their visit.
Simply PRINT, FILL OUT and BRING the completed forms with you to your appointment.
Registration Forms
All patients, regardless of the type of service they will receive, will need to complete the following forms:
Patient Privacy Notice
Patient Rights and Responsibilities
Patient Registration
Medical Records Release
Patient History Forms
Please complete the following form(s) that pertain to the screening service(s) you will be receiving:
Mammography Patient History
Bone Density (DEXA ) Patient History
Spanish Forms
Aviso de privacidad
Derechos pacientes y responsabilidades
Información del paciente y reconocimiento
Consentimiento para revelar registros medicos
Forma historial del paciente – examen de mamografía
Forma historial del paciente – examen dexa
The following forms have been provided for your convenience. Please note that these forms may not be the appropriate forms for all patients in all circumstances.
New patients can save time during their first appointment by completing the forms prior to their visit. Simply fill in the information requested, print, and bring the completed forms with you to your appointment.
Registration Forms
All patients, regardless of the type of service they will receive, will need to complete the following forms:
Patient Privacy Notice
Patient Rights and Responsibilities
Patient Registration
Medical Records Release
Patient History Forms
Please complete the following form(s) that pertain to the screening service(s) you will be receiving:
Mammography Patient History
Bone Density (DEXA ) Patient History
Spanish Forms
Aviso de privacidad
Derechos pacientes y responsabilidades
Información del paciente y reconocimiento
Consentimiento para revelar registros medicos
Forma historial del paciente – examen de mamografía
Forma historial del paciente – examen dexa
ABOUT US
Assured Imaging is the leading provider of mobile digital mammography in the United States. Collectively, our presence includes 16 full modality centers across the Northeast, Southwest, and Western U.S. in addition to operating some 40 mobile imaging coaches and portable units focused on women’s wellness in 10 different states.
CONTACT US
Corporate Headquarters
7717 N Hartman Ln
Tucson, AZ 85743
Phone: (520) 744-6121
Toll Free (888) 233-6121
Fax: (520) 572-7138
BILLING INQUIRIES
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Assured Imaging is a subsidiary of Rezolut
Assured Imaging is a subsidiary of Rezolut