MRI & Imaging of Alabama Request Free Estimate

Please complete and send for a free estimate.

Please complete and send for a free estimate.

  • Preliminary questions

  • Do you have an order? *
    Do you have an order?
  • Are you already scheduled with us? *
    Are you already scheduled with us?
  • A signed physician's order is required.

    Please contact your physician and try again with order in hand.

  • Please contact our facilty for any questions regarding an existing appointment

    Click here to visit our Mobile Open MRI page.

  • Your Information

  • Your name Your name *
  • Insurance Information

  • Will you be filing insurance? *
    Will you be filing insurance?
  • Your date of birth Your date of birth / /
  • Phone number for eligibility and benefits Phone number for eligibility and benefits - -
  • Exam Details

  • Preferred method of contact *
    Preferred method of contact
  • Primary phone number Primary phone number * - -
  • Alternate phone number Alternate phone number - -
  • Additional Information

  • PLEASE NOTE:

  • If you elected to be contacted by email, please note that all correspondence from MRI & Imaging of Alabama will be encrypted, and you will need to log into a secure portal to retrieve your messages. *
    If you elected to be contacted by email, please note that all correspondence from MRI & Imaging of Alabama will be encrypted, and you will need to log into a secure portal to retrieve your messages.
  • MedQuest, Inc. takes the security and privacy of protected health information very seriously. We have implemented technical, administrative, and physical safeguards, which are designed to protect your information from unauthorized use and access. These safeguards are intended to ensure that our system is secure and that it meets our obligations under the HIPAA Security Standards Final Rule, as well as CCHIT Meaningful Use Security Requirements to specifically protect all electronic health information created or maintained by our certified Electronic Health Record technology. By providing your information and consent, you are authorizing MRI & Imaging of Alabama to acquire certain data required to determine the scheduling necessities for the respective imaging exam you have selected on this request form. *
    MedQuest, Inc. takes the security and privacy of protected health information very seriously. We have implemented technical, administrative, and physical safeguards, which are designed to protect your information from unauthorized use and access. These safeguards are intended to ensure that our system is secure and that it meets our obligations under the HIPAA Security Standards Final Rule, as well as CCHIT Meaningful Use Security Requirements to specifically protect all electronic health information created or maintained by our certified Electronic Health Record technology. By providing your information and consent, you are authorizing MRI & Imaging of Alabama to acquire certain data required to determine the scheduling necessities for the respective imaging exam you have selected on this request form.
  • In the number 63829, what is the 1st digit?