Adler Institute for Advanced Imaging


Referring A Patient

The basic information we need from you when referring a patient.

The Clinical Value of PET/CT

How PET/CT works and why it so valuable in improving patient outcomes.

Using PET/CT

Use of PET/CT in Oncology, Cardiology, and Neurology


Necessary forms for your patient's scan.

ACR Accreditation Logo

Use the following guide when requesting a PET/CT scan for your patient:

Fax Patient Information To: 215-935-0023

  • One fax per patient

Patient Information Should Include:

  • Signed prescription designating a PET/CT and the diagnosis
  • Demographic sheet including insurance information or a completed patient scheduling form
  • Prior imaging reports (CT's, MRI's, etc.)
  • Any biopsy or surgery reports
  • Any lab results
  • Most recent doctor's notes

Upon Receipt Of Appointment Request:

  • Adler Imaging will call the patient directly, schedule the appointment, and check the insurance coverage
  • The PET/CT results will be mailed, faxed or e-mailed to the referring physician within 24-48 hours following the patient's appointment

Reimbursement/Coverage Criteria