OMI Diagnostics

Limited Time Offer Registration

Please fill out the information below an select Submit:

1.) Contact Name:	2.) Phone Number:
3.) Office Name:	4.) City:

5.) Email address for future notifications:

6.) Days in the office during the week:

7.) Best time for Marketing Reps to speak with Staff:

8.) Best time for Marketing Reps to speak with Doctors:

9.) Have used OMI locations for Diagnostic imaging in the past?:

10.) Will you consider using OMI locations for your patients diagnostic imaging services in the future?:

11.) Are there any special needs your patients may have that we are not aware of? Please describe:

12.) Are there any special needs of you office that we may not be aware of?: Please describe:

13.) How many MRI does your office refer out on a weekly basis?:

14.) How many CT’s does your office refer out on a weekly basis?:

15.) Any other comments for our staff as to how we can better service your office?: Please list below: