Diagnostic Imaging Referral

Diagnostic Imaging Referral
Waypoint Location
Patient Name

First NameLast Name
Date of Birth
Patient Number

Area CodePhone Number
Auto Insurance
Auto Insurance Claim
Attorney
Diagnostic Prescription
Type of Study, Cont
Diagnosis Codes
Special Instructions
Referring Physician
Facility
Dr. Patrick J. Mixa, MD - Waypoint Orthopaedic Associates

Please load all images to Dr. Patrick J. Mixa's existing image portal credentials.
John L. Wheeler, ARNP - Waypoint Orthopaedic Associates

Please load all images to Dr. David Braun's existing image portal credentials.
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