Looking to be scheduled right away?
Please leave us some information so we can assist you in getting scheduled ASAP! Please note, we will be contacting you by phone within 24 hours to assist you.
Name
*
First Name
Last Name
Date of Birth
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Location of Interest
Please Select
Winter Park: 111 N Lakemont Ave, STE 1A, Winter Park, FL 32792
Vineland: 5787 Vineland Rd, STE 101, Orlando, FL 32819
First Available
No Preference
Preferred Day of Week for Appointment
Monday
Tuesday
Wednesday
Thursday
Friday
No Preference
Preferred Time of Appointment
Early Morning
Before Lunch
After Lunch
Later in the Day
No Preference
Do you have the Order (Rx, Clinical Requisition)?
Please Select
Yes - If yes, please attach to this Form.
No - If No, please send Rx to orders@udiwp.com
If yes, please attach Rx to this Form (can be picture or PDF). If No, please send Rx to orders@udiwp.com
Doctor's Order for Exam - attach here.
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How did you find out about UDI?
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Google/Search Engine
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Insurance Provider
Is there anything you would like us to know?
Please note, we will be calling within 24 hours to help you schedule your appointment. We can answer any of your questions over the phone or by email.
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