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Patient Resources

Patient Portal

Patient Portal icon

Patient Portal

Patient portals allow for patients to access medical records, and communicate securely to their radiologist, among other services. The portal is available in both English and Spanish. If you need a patient portal account, you can also click this link and press the "Request an Account" button, or call our office to get started.

Additional Portal Access Forms

Online Forms

Child Proxy Form

To sign up for access to your child’s Patient Portal record, please complete both pages of this Child Proxy Form                                and return it to the included address

SWDIC Forms

Adult Proxy Form

To request access to the Patient Portal record of an adult whose medical care you help manage, please
                          complete this form.


Billing and Insurance

BillingInsurance Information

A full list of accepted insurance companies and plans. Southwest Diagnostic Imaging Center is pleased                            to provide full insurance billing and                                  claim resolution for many major                                      insurance companies

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Online Bill Pay

Our online Bill Pay feature utilizes RoyalPay credit card processing system. A RoyalPay account is not                                  required to process your payment.                                  RoyalPay accepts all major                                            credit/debit cards. For more                                            information, please contact our office.

Online Forms

Appointment Request Form

Appointment Request

You can fill out this form if you want to schedule an appointment with us. A representative will reach out with you                             within 1-2 business days

Appointment Request Form

Patient Registration

This form is for new patients. Instead of filling it out in he office, you can fill it out online before your first visit. 

 

 

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Take Our Patient Survey

Please let us know how we're doing. We want to see what we're doing well, and what we can improve on to insure                                   we're providing the best quality care to                           patients. 

Minor Consent form icon

Consent to Treatment of a Minor

If your child is getting an exam and is under 18 years of age, you must fill out this form and bring it with you on the                             day of your visit. 

Patient Videos

Patient Videos

SWDIC on YouTube

Our video library is a great resource to see our facility, equipment and our staff. Get a first look at Southwest Diagnostic Imaging Center before your visit!

 

Request for Images / Medical Records and Release Forms

Form Release Icon

Authorization for Release of Medical Images, Reports, and Medical Records

If you need to send us an results, images or records, or you need us to send any of those to another practice, you need to fill out this form. 

Medical Records/Fileroom Phone: 214-345-8457


The above forms are in PDF format and can be viewed using Adobe Acrobat Reader. If you do not have this application, visit the Adobe site at www.adobe.com to download a free copy.