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About Us
Portable X-Ray Services & Technology
Job Opportunities
FAQ’s
Blog
Contact
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Contact Details
Name of person booking x-ray
*
First
Last
Contact phone number for person booking
*
Booking facility
*
Rest Home
Private Residence
Other
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Details of property
*
Building and address
*
Patient first and last name
*
First
Last
Patient NHI
*
Patient DOB
*
Region(s) to be x-rayed
*
Funding type
*
ACC
POAC
Private
ACC
*
POAC
*
Referring practitioners name
*
Referring practitioners clinic & address
*
Any additional relevant information?
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