Schedule A Study Schedule A Study Please select the type of dysphagia imaging you would like to order by filling out the form below. Schedule A Study Please Select A State * Please Select A StateAlabamaDelawareDistrict of ColombiaFloridaGeorgiaIllinoisMarylandMichiganMissouriNorth CarolinaOhioPennsylvaniaSouth CarolinaTennesseeTexasVirginiaWest VirginiaWisconsin Please Select An Illinois County * Select A CountyBondBooneCalhounChristianClintonCookDeKalbDuPageEffinghamFayetteFranklinGreeneJacksonJeffersonJerseyJohnsonKaneKendallLakeMacoupinMadisonMarionMcHenryMonroeMontgomeryMorganPerryRandolphSangamonSt. ClairStephensonUnionWashingtonWillWilliamsonWinnebago Southern Illinois Services Provided * Select A ServiceMBS Northern Illinois Services Provided * Select A ServiceMBS Please complete the following steps to request a study with our scheduling team. 1. Download Forms Download Patient Authorization Form Download Patient Referral Form 2. Complete Forms3. Start the process of scheduling a study-Email – [email protected]-Fax – 816-817-0922-Call – 816-866-4643Once we receive your information, the Patheous Health scheduling team will contact you.4. Review Day of Study checklist prior to appointment Download Day of Study Checklist Please complete the following steps to request a study with our scheduling team. 1. Download Forms Download Patient Authorization Form Download Patient Referral Form 2. Complete Forms3. Start the process of scheduling a study-Email – [email protected]-Fax – 816-817-0922-Call – 816-866-4643Once we receive your information, the Patheous Health scheduling team will contact you.4. Review Day of Study checklist prior to appointment Download Day of Study Checklist Please Select A Michigan County * Select A CountyAlleganBayBranchCalhounClintonEatonGenesseGrand TraverseGratiotHillsdaleInghamIsabellaJacksonKalamazooLapeerLenaweeLivingstonMacombMonroeMontcalmOaklandOttawaSaginawShiawasseeSt. ClairTuscolaWashtenawWayne Michigan Services Provided * Select A ServiceMBSFEES Michigan Services Provided * Select A ServiceMBS Michigan Services Provided * Select A ServiceFEES Please complete the following steps to request a study with our scheduling team. 1. Download Forms Download Patient Authorization Form Download Patient Referral Form 2. Complete Forms3. Start the process of scheduling a study-Email – [email protected]-Fax – 330-923-3507-Call – 888-225-9227 or 330-923-3502Once we receive your information, the Patheous Health scheduling team will contact you.4. Review Day of Study checklist prior to appointment Download Day of Study Checklist Please complete the following steps to request a study with our scheduling team. 1. Download Forms Download Patient Authorization Form Download Patient Referral Form 2. Complete Forms3. Start the process of scheduling a study-Email – [email protected]-Fax – 330-923-3507-Call – 888-225-9227 or 330-923-3502Once we receive your information, the Patheous Health scheduling team will contact you.4. Review Day of Study checklist prior to appointment Download Day of Study Checklist Click Here To Schedule Your FEES Study Please Select A Missouri County * Select A CountyAudrainBollingerCallawayCape GirardeauCity of St. LouisCrawfordDentFranklinGasconadeIronJeffersonLincolnMadisonMariesMontgomeryOsagePerryPhelpsPikeRallsReynoldsSt. CharlesSt. FrancoisSte. GenevieveSt. Louis CountyWarrenWashington Missouri Services Provided * Select A ServiceMBS Please complete the following steps to request a study with our scheduling team. 1. Download Forms Download Patient Authorization Form Download Patient Referral Form 2. Complete Forms3. Start the process of scheduling a study-Email – [email protected]-Fax –816-817-0922-Call –816-866-4643Once we receive your information, the Patheous Health scheduling team will contact you.4. Review Day of Study checklist prior to appointment Download Day of Study Checklist Please Select A North Carolina County * Select A CountyAlamanceAlexanderAlleghanyAnsonAsheAveryBeaufortBertieBrunswickBuncombeBurkeCabarrusCaldwellCarteretCatawbaChathamCherokeeClayClevelandColumbusCravenCumberlandCurrituckDanburyDareDavidsonDavieDuplinDurhamEdgecombeForsythFranklinGastonGatesGrahamGranvilleGuilfordHalifaxHarnettHaywoodHendersonHertfordHokeIredellJacksonJohnstonJonesLeeLenoirLincolnMaconMadisonMartinMcDowellMecklenburgMitchellMontgomeryMooreNashNew HanoverNorthamptonOnslowPamlicoPasquotankPenderPerquimansPersonPittPolkRandolphRichmondRobesonRockinghamRowanRutherfordScotlandStanlyStokesSurrySwainTransylvaniaUnionVanceWakeWarrenWashingtonWataugaWayneWilkesWilsonYadkinYanceyOrange North Carolina Services Provided * Select A ServiceMBSFEES North Carolina Services Provided * Select A ServiceFEES [ Click Here To Schedule Your FEES Study Please complete the following steps to request a study with our scheduling team. 1. Download Forms Download Patient Authorization Form Download Patient Referral Form 2. Complete Forms 3. Start the process of scheduling a study -Email – [email protected] -Fax – 984-259-1501 -Call – 984-259-1501 Once we receive your information, the Patheous Health scheduling team will contact you. 4. Review Day of Study checklist prior to appointment Download Day of Study Checklist Please Select An Ohio County * Select A CountyAllenAshlandAshtabulaAthensBelmontButlerCarrollChampaignClarkClermontClintonColumbianaCoshoctonCrawfordCuyahogaDarkeDefianceDelawareErieFairfieldFayetteFranklinFultonGalliaGeaugaGreeneHamiltonHancockHardinHenryHighlandHockingHolmesHuronJeffersonKnoxLakeLickingLoganLorainLucasMadisonMahoningMarionMedinaMiamiMonroeMontgomeryMorganMorrowMuskingumNobleOttawaPerryPickawayPortagePreblePutnamRichlandRossSanduskySenecaShelbyStarkSummitTrumbullTuscarawasUnionVintonWarrenWashingtonWayneWilliamsWoodWyandot Ohio Services Provided * Select A ServiceMBSFEES Ohio Services Provided * Select A ServiceFEES Please complete the following steps to request a study with our scheduling team. 1. Download Forms Download Patient Authorization Form Download Patient Referral Form 2. Complete Forms 3. Start the process of scheduling a study -Email – [email protected] -Fax – 330-923-3507 -Call – 888-225-9227 or 330-923-3502 Once we receive your information, the Patheous Health scheduling team will contact you. 4. Review Day of Study checklist prior to appointment Download Day of Study Checklist Click Here To Schedule Your FEES Study Please Select A West Virginia County * Select A CountyBerkeleyBrookeGreenbrierHancockHarrisonJeffersonLewisMarionMarshallMcDowellMercerMineralMonongaliaMonroeMorganPendletonPleasantsPocahontasPrestonRaleighRandolphSummersTaylorTylerWoodWyoming West Virginia Services Provided * Select A ServiceFEES Click Here To Schedule Your FEES Study Please Select A Wisconsin County * Select A CountyKenoshaMilwaukeeRacineWaukesha Wisconsin Services Provided * Select A ServiceMBS Please complete the following steps to request a study with our scheduling team. 1. Download Forms Download Patient Authorization Form Download Patient Referral Form 2. Complete Forms3. Start the process of scheduling a study-Email – [email protected]-Fax – 816-817-0922-Call – 816-866-4643Once we receive your information, the Patheous Health scheduling team will contact you.4. Review Day of Study checklist prior to appointment Download Day of Study Checklist Please Select A Tennessee County * Select A CountyBradleyHamiltonMarionPolk Tennessee Services Provided * Select A ServiceFEES Please Select A Georgia County * Select A CountyBaconBakerBaldwinBanksBarrowBartowBen HillBibbBleckleyBrantleyBryanBullochBurkeButtsCalhounCamdenCandlerCarrollCatoosaCharltonChathamChattahoocheeChattoogaCherokeeClarkeClayClaytonClinchCobbCoffeeColquittColumbiaCowetaCrawfordCrispDadeDawsonDecaturDeKalbDodgeDoolyDoughertyDouglasEarlyEcholsEffinghamElbertEmanuelEvansFanninFayetteFloydForsythFranklinFultonGilmerGordonGlynnGradyGreeneGwinnettHabershamHallHancockHaralsonHarrisHartHeardHenryHoustonIrwinJacksonJasperJeffersonJenkinsJohnsonJonesLamarLaurensLeeLibertyLincolnLowndesLumpkinMaconMadisonMarionMcDuffieMeriwetherMillerMitchellMonroeMontgomeryMorganMurrayMuscogeeNewtonOconeeOglethorpePauldingPeachPickensPiercePikePolkPulaskiPutnamQuitmanRabunRandolphRichmondRockdaleSchleyScrevenSeminoleSpaldingStephensStewartSumterTalbotTaliaferroTattnallTaylorTelfairTerrellTreutlenTiftThomasToombsTownsTroupTurnerTwiggsUnionUpsonWalkerWaltonWareWashingtonWayneWebsterWheelerWhiteWhitfieldWilcoxWilkesWilkinsonWorth Georgia Services Provided * Select A ServiceFEES Please Select A District of Columbia County * Select A CountyWashington District of Columbia Services Provided * Select A ServiceFEES Please Select A Maryland County * Select A CountyAlleganyAnne ArundelBaltimore CityBaltimore CountyCalvertCarolineCarrollCecilCharlesFrederickGarrettHarfordHowardKentMontgomeryPrince George’sQueen Anne’sSomersetSt. Mary’sTalbotWashingtonWorcester Maryland Services Provided * Select A ServiceFEES Please Select A Virginia County * Select A CountyAlbemarleAlexandriaAlexandria CityAlleghanyAmeliaAmherstAppomattoxArlingtonAugustaBathBedford CountyBlandBotetourtBristol CityBrunswickBuckinghamBuena VistaCampbellCarolineCarrollCharles CityCharlotteCharlottesvilleCharlottesville CityChesapeakeChesapeake CityChesterfieldClarkeCovingtonCraigCulpeperCumberlandDanvilleDanville CityDinwiddieEmporiaEssexFairfaxFairfax CountyFairfax CityFalls ChurchFauquierFloydFluvannaFranklin CountyFranklin CoFrederickFredericksburgGalaxGilesGloucesterGoochlandGraysonGreeneGreensvilleHalifaxHamptonHampton CityHanoverHarrisonburgHarrisonburg CityHenricoHenryHighlandIsle of WightJames CityKing and QueenKing GeorgeKing WilliamLancasterLeeLexingtonLoudounLouisaLunenburgLynchburgLynchburg CityMadisonManassasManassas ParkMartinsvilleMartinsville CityMathewsMecklenburgMiddlesexMontgomeryNelsonNew KentNewport NewsNewport News CityNorfolkNorfolk CityNorthamptonNorthumberlandNottowayOrangePagePatrickPetersburgPetersburg CityPittsylvaniaPoquosonPoquoson CityPortsmouthPortsmouth CityPowhatanPrince EdwardPrince GeorgePrince WilliamPulaskiRadfordRappahannockRichmondRichmond CityRichmond CountyRoanokeRoanoke CityRoanoke CountyRockbridgeRockinghamSalemSouthamptonSpotsylvaniaStaffordStauntonStaunton CitySuffolkSuffolk CitySurrySussexTazewellVirginia BeachVirginia Beach CityWarrenWashingtonWaynesboroWaynesboro CityWestmorelandWinchesterWinchester CityWytheYork Virginia Services Provided * Select A ServiceFEES Please Select An Alabama County * Select A CountyAutaugaBibbBlountCalhounChiltonClayCoosaCullmanDallasElmoreEtowahFayetteHaleHoustonJeffersonMadisonMarionMarshallMorganPerryRussellShelbySt. ClairTalladegaTallapoosaTuscaloosaWalkerWinston Alabama Services Provided * Select A ServiceFEES Please Select A South Carolina County * Select A ServiceAbbevilleAikenAllendaleAndersonBambergBarnwellBeaufortBerkeleyCalhounCharlestonCherokeeChesterClarendonColletonDarlingtonDorchesterEdgefieldFairfieldFlorenceGeorgetownGreenvilleGreenwoodHamptonHorryJasperKershawLancasterLaurensLeeLexingtonMarlboroMarionMcCormickNewberryOconeeOrangeburgPickensRichlandSaludaSpartanburgSumterUnionWilliamsburgYork South Carolina Services Provided * Select A CountyFEES Please Select A Delaware County * Select A ServiceKentNew CastleSussex Delaware Services Provided * Select A CountyFEES Please Select A Florida County * Select A ServiceAlachuaBakerBayBradfordBrevardBrowardCalhounCharlotteCitrusClayCollierColumbiaDeSotoDixieDuvalFlaglerFranklinGadsdenGilchristGulfHamiltonHardeeHendryHernandoHighlandsHillsboroughIndian RiverJacksonJeffersonLafayetteLakeLeeLeonLevyLibertyMadisonManateeMarionMartinMiami-dadeNassauOkeechobeeOrangeOsceolaPalm BeachPascoPinellasPolkPutnamSarasotaSeminoleSt. JohnsSt. LucieSumterSuwanneeTaylorUnionVolusiaWakullaWashington Florida Services Provided * Select A CountyFEES Please Select A Pennsylvania County * Select A ServiceAdamsAlleghenyArmstrongBeaverBerksBlairBucksButlerCambriaCarbonChesterClarionClearfieldCrawfordCumberlandDauphinDelawareFayetteFranklinGreeneIndianaJeffersonLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMercerMonroeMontgomeryNorthamptonNorthumberlandPerryPhiladelphiaPikeSchuylkillSomersetVenangoWannaWashingtonWayneWestmorelandYork Pennsylvania Services Provided * Select A CountyFEES Please Select A Texas County * Select A ServiceAndersonBellBosqueCampClayCollinComancheCookeDallasDentonEctorEllisErathFanninFranklinFreestoneGraysonGreggHendersonHillHoodHopkinsHuntJackJohnsonKaufmanLamarLimestoneMcLennanMidlandMontagueNavarroPalo PintoParkerProsperRainsRed RiverRockwallSmithSomervellTarrantTitusUpshurVan ZandtWichitaWiseWood Texas Services Provided * Select A CountyFEES Texas Services Provided * Select A CountyFEESMBSPediatric MBS Click Here To Schedule Your FEES Study All Patheous MBS procedures in this area are provided by DiagnosTEX a Patheous Health Company. Email: [email protected] Fax: 817-514-6278 or 888-920-1201 Call: 817-514-6271 or 888-514-6271 MBS Referral Form Authorization to Evaluate/Release of Information All Patheous MBS procedures in this area are provided by DiagnosTEX a Patheous Health Company. Email: [email protected] Fax: 817-514-6278 or 888-920-1201 Call: 817-514-6271 or 888-514-6271 Download Your Scheduling Documents Here: ⤓ English Version ⤓ Spanish Version Texas Services Provided * Select A CountyFEESMBSPediatric MBS Click Here To Schedule Your FEES Study All Patheous MBS procedures in this area are provided by DiagnosTEX a Patheous Health Company. Email: [email protected] Fax: 817-514-6278 or 888-920-1201 Call: 817-514-6271 or 888-514-6271 MBS Referral Form Authorization to Evaluate/Release of Information All Patheous MBS procedures in this area are provided by DiagnosTEX a Patheous Health Company. Email: [email protected] Fax: 817-514-6278 or 888-920-1201 Call: 817-514-6271 or 888-514-6271 Download Your Scheduling Documents Here: ⤓ English Version ⤓ Spanish Version Submit If you are human, leave this field blank. ΆDon't see your location listed? Other scheduling inquiries? Call 919-889-7235
