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Midwest Dysphagia Consultants

Home
About
What We Do
Studies
Contact
FAQs
Downloads
Provider Portal
Online Scheduling Form

Downloads

Documents

  • Intake (scheduling) form for Facilities (Hospitals and SNFs)

  • Intake (scheduling) form for Home Health Patients (Assisted Living and Independent Living)

  • Intake (scheduling) for Pediatric Patients

  • Signature page for Online Scheduling Form

  • EHR Certificate of Compliance

  • ONC HIT Certification

  • Certificate of General Liability Coverage

  • Certificate of Medical Malpractice Coverage

  • Medicare Part B Consolidated Billing Information

Phone: 1-855-209-1979 | (513) 713 - 0069
Fax: 1-855-208-1848
mdcoffice@proimagetx.com

 

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