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1
Study type and Image Upload
2
Patient Details
3
Clinical Details
4
Case Details
Study Type
(Required)
Study Type
Standard X-ray - $22.00 AUD / £12.00 UK / €14.00 EUR / $16.00 USD
Standard Ultrasound - $45.00 AUD / £24.00 UK / €28.00 EUR / $32.00 USD
Standard CT scan - $110.00 AUD / £58.00 UK / €68.00 EUR / $77.00 USD
MRI Report (per region) - $140.00 AUD / £77.00 UK / €88.00 EUR / $99.00 USD
Procedure
(Required)
Report Delivery
(Required)
Report Delivery
Routine (24hrs)
Medically Urgent (4hrs)
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Supported file types include jpg, bmp, tif, zip and dcm. Upload up to 800 images. Max upload 512MB.
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Images
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Accepted file types: jpg, jpeg, bmp, tif, zip, dcm, Max. file size: 660 MB, Max. files: 20.
Patient First name
(Required)
Patient Last name
(Required)
Title
Title
Mr
Mrs
Miss
Ms
Dr
DOB
(Required)
DD slash MM slash YYYY
Patient address
(Required)
I have obtained the above patient's signed consent to x-ray and send the study to PRO for reporting.
(Required)
Yes
No
Clinical Details
This Case
Date of Study
(Required)
DD slash MM slash YYYY
Practice Location
(Required)
Referring Practitioner
(Required)
Report Delivery
Report Delivery
Comments
This field is for validation purposes and should be left unchanged.
Subtotal
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Total
Medical quantity
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