Request Order Pads Service Order Pads are used by referring providers to order imaging exams. Providers can request referral pads by completing the form below, and a Sales Specialist will deliver them directly to your office. Email Name First Last PracticeAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office PhoneThe CIS location order form you wish to order:* Advanced Imaging of Lafayette - Lafayette LA Alliance - Clear Lake Alliance - Katy Alliance - Lake Houston Alliance - Lake Jackson Alliance - Montgomery County Alliance - Pearland Alliance - Spring Alliance - Woodforest Alliance - The Woodlands Ascension Open MRI - Gonzales LA Baton Rouge Imaging Center - Baton Rouge LA Bluebonnet Imaging Center - Baton Rouge LA Central Imaging Center - Baton Rouge LA Diagnostic Imaging Services - Covington, LA Highway 21 Diagnostic Imaging Services - Covington, LA Pinnacle Parkway Diagnostic Imaging Services - Marrero, LA Diagnostic Imaging Services - Metairie, LA Houma Boulevard Diagnostic Imaging Services - Metairie, LA Veterans Boulevard Diagnostic Imaging Services - Slidell, LA Diagnostic Imaging Services - Thibodaux, LA Doctors Imaging - Metairie LA Heritage Diagnostic Center - Cullman AL Homosassa Open MRI - Homosassa FL Houston Premier Radiology Center - Houston, TX Houston MRI - Cypress Houston MRI - East Houston Houston MRI - Friendswood Houston MRI - Katy Houston MRI - Sugar Land Houston MRI - The Woodlands Houston MRI - West Houston Imaging Center of Columbus - Columbus MS Imaging Center of Meridian - Meridian MS Louisiana PET/CT Imaging of Lake Charles - Lake Charles LA M.R. Imaging Systems - Alexandria LA Northeast Imaging - Monroe LA Northwest Imaging - Shreveport LA Open Air MRI of CENLA - Alexandria LA Open MRI of Hammond - Hammond LA Open MRI of Mississippi - Flowood MS OPI - Atlanta OPI - Canton OPI - Decatur OPI - Fayetteville OPI - Kennestone OPI - Marietta OPI - Newnan OPI - Peachtree City OPI - Statesboro PARS Imaging - Baytown TX Radiology & Imaging - Alameda - Corpus Christi, TX Radiology & Imaging - South - Corpus Christi, TX River Bend Imaging - Laplace LA Southern Imaging Specialists - Montgomery AL Texarkana PET/CT imaging Institute - Texarkana TX Vestavia Hills Imaging Center - Vestavia Hills AL Number of Pads:Other Supplies: Pens and Pads Needed: CIS Pens (black ink) CIS 3"x3" Note Pads (25 sheets per pad) Other information I would like to receive or specific questions I have: Δ