Prepare for Your Visit
Patient Info
Helping with Your Care
Thank you for choosing SimonMed Imaging for your medical imaging. For your added convenience please use the links below.
Click here to complete your forms online prior to your appointment.
For any additional questions, please call or text us at
1-866-614-8555 or email us at info@SimonMed.com.
Prep Instructions (Open Link in new window)
Preparation Instructions to review before your exam.
Medical Records Request Form - English (Open Link in new window)
Authorization to Release PHI.
Medical Records Request Form - Spanish (Open Link in new window)
Authorization to Release PHI
Medical Records Policy (Open Link in new window)
Process of Requesting Medical Records.
Patient Lien Form - English (Open Link in new window)
Authorization to Release PHI to Attorney
Patient Lien Form - Spanish (Open Link in new window)
Authorization to Release PHI to Attorney
Cost Estimates Explained (Open Link in new window)
SimonMed provides estimates based on insurance provided
Patient Lien Form English - AZ (Open Link in new window)
Lien Form for Patients in Arizona
Patient Lien Form Spanish - AZ (Open Link in new window)
Lien Form for Patients in Arizona
Why Choose Us
SimonMed Imaging and its affiliates have been serving the community for over 30 years. Our mission is to provide best-in class affordable care through the use of advanced technology. We have patient-focused staff and highly trained medical professionals.
SimonMed has over 160 convenient locations across 11 states and provides late night and weekend appointments to accommodate patients.
