Palms Imaging Center About Us Services Meet Our Staff Patient Care Women’s Center Physician Login News/Media Contact Us INSURANCE & BILLING Accepted Insurance Carriers Palms Imaging Center is a preferred provider for the following insurance carriers: PPOS Aetna Blue Cross Blue Shield EBA&M Cigna GEHA HealthNet Tricare Western Growers United Health HMOS Kaiser Permanente Regal HMO OTHER Healthy Families Program GCHP – Gold Coast Health Plan Medicare Medi-Cal Worker’s Compensation VCHCP – Ventura County Health Care Plan Covered California *Cash payments and co-pays are due at time of appointment. **Ask about payment options for patients with financial hardships. QUESTIONS Questions about your bill should be directed to: Computerized Management Services (CMS) Customer Service:(800) 535-1004 Monday – Friday 9am to 5pm P O Box 190 Simi Valley, CA 93062 Hours of Operation Mon-Fri 7:00 AM-8:00 PM Saturday 8:00 AM-2:00 PM Request an Appointment Services PET/CT CT/CTA MRI/MRA PROSTATE MULTIPARAMETRIC MRI Abbreviated Breast MRI (AB-MR) Interventional Radiology 3D Mammography Ultrasound DEXA X-ray Copyright © 2021 · All Rights Reserved · Palms Imaging Center

Palms Imaging Center About Us Services Meet Our Staff Patient Care Women’s Center Physician Login News/Media Contact Us FORMS Here you will find some of Palms Imaging Center’s commonly used forms. Just download, complete the fields and print to sign and mail or fax to the office. Patients can bring these completed forms with them to shorten their registration time! New Patient Registration (English I Español) Patient Medical History (English I Español) MRI Screening Form (English I Español) Breast Screening Form (English I Español) DEXA History Questionnaire (English I Español) OB/Ultrasound Questionnaire (English I Español) Pelvic Ultrasound Questionnaire (English I Español) PET/CT Informed Consent (English I Español) Consent Form for use of Contrast Material (English I Español) Prescription (PDF) OB Prescription (PDF) All forms are presented in Adobe PDF format. If you do not have an Adobe PDF reader, you may download this quick and easy program for free! Hours of Operation Mon-Fri 7:00 AM-8:00 PM Saturday 8:00 AM-2:00 PM Request an Appointment Services PET/CT CT/CTA MRI/MRA PROSTATE MULTIPARAMETRIC MRI Abbreviated Breast MRI (AB-MR) Interventional Radiology 3D Mammography Ultrasound DEXA X-ray Copyright © 2021 · All Rights Reserved · Palms Imaging Center