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Submit X-Ray Files for Digitizing

Click to view our DIGITAL ANALYSIS REQUIREMENTS for details on specific x-ray views needed.

 

Please click to print and complete the following forms and then scan them. You will be uploading the digital version below.


1. Registration Form 2. Permission to Transmit 3. Chain of Trust 4. Lien/Letter of Protection 5. Medical Necessity

 

'Then complete the information below, attach each form file as well as your x-ray files. You may also zip them and attach as one.

After pressing the Submit button, your files will be uploaded, a case number will be assigned, and you will receive a confirmation email (as long as the email address you submit is correct). Spine Metrics will keep you apprised of the progress of your case.

 

Please note that our server currently is limited to a 10 minute upload connection and a max upload of 50MB. If you receive an error, please split your files into two batches and try again.

 

 

 

SUBMITTED BY





 

Requested Analysis:         X-ray Required
Cervical AOMSI flex / ext
Lumbar AOMSI flex / ext
Full Spine AP: C, T, L LAT: C, T, L
Cervical Motion CERV: flex / ext
Lumbar Motion LUM: flex / ext
Cervical lateral bend CERV: R / L lateral bend
Lumbar lateral bend LUMB: R / L lateral bend
Scoliosis same as full spine