Imaging Onboarding
Hello! Please fill out the form and reach out to our provider network specialist at pnteam@readyrebound.com if you have any questions.
Group Name
*
Office 1: If your group has more than one location, please add each
General Office Contact Info
🚨Cell phone numbers will only be utilized by Ready Rebound clinical staff on an as needed basis🚨
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Fax
Please enter a valid phone number.
Website
Please enter the insurance companies that you do NOT accept:
Provider Name(s)
(If Applicable)
Please fill out for each provider
Imaging Info
*
MRI
MRI Arthrogram
CT
Ultrasound
Other
Specifications (1.5 vs. 3t, wide vs. open)
If applicable: What is the minimum pediatric age you will service?
Office Contacts
Scheduler Contact
Do you have a separate administrative and/or escalation point of contact?
*
Yes
No
Administrative/ Escalation Contacts
Do you have a seperate workers compensation contact?
Yes
No
Work Comp Contact
Submit
Should be Empty: