Terms of Use

Thank you for visiting the Physician Forms section of our Web site. Please take a few moments to read and accept our Terms of Use. You must agree to these terms in order to proceed to the secure area of our Web site.

In order to use our online forms, your information must be registered with our Marketing Department. The process is fast and easy, and helps us verify your identity and keeps your information secure. To sign up, please call:

We’ll request your first and last name, and a valid E-mail address and phone number. Within 24 hours, your account will be set up and you may begin submitting exam requisitions online. For your security, we’ll ask for these same three items every time you sign on, so it’s important that the data you enter online matches the information given when you signed up for the account. Without an exact match, the form will not be submitted.

All identifying personal information will be encrypted and will be used solely by Southwest Diagnostic Imaging Center. Messages will not be internally or externally forwarded to third parties. Southwest Diagnostic Imaging Center will not be held responsible for electronic message transmission failures caused by technical problems related to this site or its hosting server.

Your request will be processed within 24 hours from the time it was received, within normal business hours (Monday through Friday, 8:00 a.m. to 5:00 p.m., excluding holidays).

If you do not accept the terms of this disclaimer, we will not be able to process your online request. Please contact our office with any questions regarding the use of these forms. We appreciate your interest in Southwest Diagnostic Imaging Center and look forward to serving you and your patients.

By entering your e-mail address, password and selecting the continue button below to submit an online requisition, you are accepting the term of this disclaimer.