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Chiropractic
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1
Study type and Image Upload
2
Patient Details
3
Clinical Details
4
Case Details
Study Type
(Required)
Study Type
X-Ray Sectional report (1 region) - $33.00 AUD / £17.25 UK / €20.50 EUR / $23.00 USD
X-Ray Full spine report (2+ regions) - $55.00 AUD / £31.00 UK / €36.50 EUR / $41.00 USD
MRI Report - $395.00 AUD / £220.00 UK / €250.00 EUR / $295.00 USD
MRI Report (per region) - $140.00 AUD / £77.00 UK / €88.00 EUR / $99.00 USD
Procedure Type
(Required)
Procedure Type
Cervical Spine
Thoracic Spine
Lumbar Spine, Pelvis and Hips
Full Spine
Hip
Knee
Shoulder
Other
Report Delivery
(Required)
Report Delivery
Routine (24hrs)
Medically Urgent (4hrs)
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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: 800.
Patient First Name
(Required)
Patient Last Name
(Required)
Title
Title
Mr
Mrs
Miss
Ms
Dr
Patient DOB
(Required)
DD slash MM slash YYYY
Patient Address
I have obtained the above patient's signed consent to x-ray and send the study to PRO for reporting.
(Required)
Yes
No
Biomechanical Analysis
Inc. scoliosis/sagittal curves/spondylolisthesis/leg length/subluxation/etc
Pain
Cx
Tx
Lx
Ribs
Coccyx
SIJ
Restricted ROM
Cx
Tx
Lx
Degeneration
Cx
Tx
Lx
Instability
Cx
Tx
Lx
Inflammatory Arthritis
Cx
Tx
Lx
SIJ
Headache
Headache
Cervicogenic
Tension
Migrane
Cluster
Exertional
Other
Other Details
Past surgeries
Hx of Cancer
Other Clinical Details
This Case
Date of Study
(Required)
DD slash MM slash YYYY
Practice Location
(Required)
Referring Practitioner
(Required)
Report Delivery
Report Delivery
Subtotal
Options
Total
Chiropractic quantity
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