If you prefer to fax us a referral, simply print and fax this form: Referral Form.
If you would like to refer a patient to AEC using our online submittal, please complete the form below...
You may optionally upload any diagnostic files, x-ray .jpg images or other patient documents as required. We will process your submittal at the hospital location you select, and send a confirmation email back to you indicating that we have received your information.
Note: If you would like to do a DICOM send directly from your digital radiography system to AEC, please contact us for assistance: DICOM Send.