Submit the completed form via email to PSScheduling@RAYUSradiology.com or fax to 425.251.4307. Ensure all required fields are filled out, and attach any necessary documents requested. For physical submissions, mail the form to the nearest RAYUS Radiology center listed in the contact information.

Important dates include insurance renewal, patient eligibility verification, and appointment scheduling deadlines for imaging services. Please ensure you check with your insurance provider to confirm coverage before submitting the form. Mark your calendar for any relevant appointments to ensure timely imaging services.

The purpose of this form is to gather comprehensive information necessary for scheduling medical imaging appointments at RAYUS Radiology centers. It ensures that all relevant details such as patient identification, insurance coverage, and selected imaging procedures are accurately documented. This information streamlines the appointment process, enhances communication between patients and providers, and ensures compliance with insurance requirements.

• 1. Patient Name: Enter the patient's full name as it appears on the insurance card.
• 2. Date of Birth: Provide the patient's date of birth for identification.
• 3. Insurance Details: Fill in the insurance company name and policy number.
• 4. Contact Numbers: Enter primary and secondary contact numbers.
• 5. Selected Imaging Services: Select the specific imaging services required for the appointment.

If the form is not submitted correctly, it may delay appointment scheduling and insurance verification. Make sure all fields are filled completely to avoid processing issues. Incomplete forms may result in additional follow-up and delays.

• Delays in Appointment Scheduling: Incomplete submissions can lead to delays in scheduling your imaging procedure.
• Insurance Verification Issues: Missing information may result in challenges with insurance coverage and approval.
• Increased Administrative Burden: Errors in the form can create additional workload for staff to resolve issues.

• 1. When Booking Imaging Appointments: Use this form to book any type of imaging service, ensuring all details are captured.
• 2. Insurance Coordination: This form helps to document patient insurance information for billing purposes.
• 3. Pre-Appointment Information Gathering: Collect required data prior to patient's visit to enhance efficiency.