Printable Order Forms
These standard PDFs can be printed, filled out by hand and signed by providers. Schedulers can then fax the order to Wake Radiology at 919-235-3940 (Main) or 919-933-9925 (Chapel Hill).
If you need more order form pads, educational materials or other supplies, please contact your physician liaison. If you don’t know who your physician liaison is, contact April White, Director of Physician Liaison Services. April can be reached at 919-788-7908 (office), 919-632-3318 (cell) or via email.
| Main Order Form
| Breast MRI
& Sports Imaging
Both the updated portal and the Form Center use PDFs to share information that wasn’t previously available. PDFs are cross-platform files can be viewed and printed on any computer. Many systems have this capability built into their operating systems. Others rely on Adobe Reader for this function.
If you experience problems with PDFs, please try these tips.
- Windows: Right click on the icon or button and save the file to your desktop
- Mac: Control click on the icon or button and save the file to your desktop
- Then, double-click the file to print or move it to a different place within your system
CMS Signature Guidelines
All orders submitted to Wake Radiology must meet CMS signature guidelines. Learn more by downloading this guidelines.