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CALL:  855-455-8900
SECURE FAX:  855-455-8222
Chesapeake Imaging

Order Exam

Exam order forms are in in printable PDF format. Please click the link to open and print.
Upon completion:

  1. Fax to:  1-855-455-8222OR-  scheduling@cmimail.net
  2. Give to the patient for their appointment.

Provider Order Form

Provider Order Form (Spanish)

Neurology Order Form

Lung Cancer Screening Program Order Form

Click here for Ordering Guides.

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