Financial Agreement

Click here to download the Financial Services Agreement and Authorization Form (Right-Click and Save)



Click here to download an MRI Requisition (Right-Click and Save)



Click here to download an Ultrasound Requisition (Right-Click and Save)

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Peace Regional MRI and Ultrasound aims to assist patients who are pursing legal claims, where an MRI or Ultrasound will help to support their case or facilitate a resolution of claim. By obtaining imaging early in the preparation of a legal case, or when determining the validity of an insurance claim, the typically lengthy process of pursuing a case may be shortened. All individuals with an active insurance claim where personal injury is a factor should have an MRI exam to validate the extent of their injuries.

Law firms need only submit a Requisition, along with the Financial Services Agreement and Authorization form to gain instant access to MRI imaging for their clients. No fee need be paid at the time of imaging. Full payment is due only when the case has been resolved or discharged. All MRI imaging services are provided at our regular posted rates and those accounts that have not been settled with 30 days from the exam date are subject to an interest charge of 10% per annum.

Once approval has been obtained, the client just needs to attend their MRI or Ultrasound appointment. The patient does not need to make any payment to receive their MRI or Ultrasound scan. The law firm needs only to enter the obligation to pay into their undertaking reminder system to insure payment is made once the case has been settled. The report and CD of MRI images will be forwarded directly to the lawyer's office.

Both the Financal Agreement form and the Requisition are accessible through the links on the left. These may be saved on your computer for future use by right-clicking the links and selecting "Save Link As".

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