Dynamic Medical Solutions - Scheduling Request

Therapist Contact Information

PATIENT INFORMATION

PATIENT INSURANCE INFORMATION

PAPERWORK TO BE PROVIDED AT TIME OF STUDY

As part of almost any medical procedure, a Patient Authorization form must be completed. Please go to, www.dmsiok.com/forms, and complete the Patient Authorization Form. This form will need to be completed and provided at the time of study. Also located on the DMS Forms page, is a Physician's Order Form for your use. The Physician's Order Form makes the ordering process simple, and contains the required details for ordering a study.

IMPORTANT: All Physician's Orders MUST be signed by physician BEFORE STUDY IS SCHEDULED.
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