(732) 671 -6618 100 Commons Way Suite 100, Holmdel , NJ 07733 www.holmdelimaging.com

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How to get Imaging Authorizations: 1. Fill out the registration form on the reverse side (first time only). 2. Preauthorization form must be filled out for every patient/exam to be authorized. 3. Information Needed: Prescription, Insurance Card , Additional clinical notes/previous exams, if necessary 4. Fax completed forms, prescription, insurance card, and any additional information, if needed, to 732-671-6902. 5. Once the authorization is obtained we will call you and advise when the patient is scheduled for their exam. Give us a call to learn how we can help with your authorization needs!

Need Assistance with Authorizations? Save yourself valuable time! Let us schedule your patient appointments AND obtain the required authorizations for you! Our team at Holmdel Imaging is able to obtain the needed authorizations for most insurance carriers in our network!

100 Commons Way Suite 100, Holmdel, NJ 07733 P: 732.671.6618

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