Edmonton Diagnostic Imaging - Patient Referral Slip

6643-177th Street, Edmonton AB, T5T 4K3 (P) 780-483-1338 (F) 780-483-1393 info@edxi.com


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Patient Insurance Information

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Cone Beam Volumetric scan to be taken at EDI

What is your preferred method to return results?:            
           
       
Implant
Measurements: Yes No
     Nerve tracing: Yes No

Orthodontic Records

Invisalign Records

   

Models: