About The Bonati Spine Institute
over 25 years experience

Advantages of Our Procedures
less pain, faster recovery

What We Treat
find out if procedures are right for you

Surgical Procedures
outpatient spine surgeries that work

Meet Our Physicians
world class board-certified MD's

Kiersten was unable to walk before coming to The Bonati Spine Institute
a see Kiersten′s story

26 year old Sean O′Dell′s amazing success story of recovery
see Sean′s story

see more patient testimonials

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MRI Review

The Bonati Spine Institute offers a comprehensive review of your MRI film or CD with no obligation to you, provided that your most recent MRI scan is less than 12 months old. Our Radiologist, M.D. will review your MRI scan and note each condition, its cause and severity. Then, our Physician’s Assistant will discuss the findings with you to see if you are a candidate for the Patented Bonati Procedures.

The Bonati Spine Institute is not a Medicare provider, but can treat persons insured by Medicare on a “self-pay” basis.

* Required

First Name:	*
Last Name:	*
Address:	*
City:	*
Country:	*
State:	*
Zip:	*
Phone:	*
Email:	*
Briefly describe your condition:
Symptoms:
Type of insurance:	* The Bonati Spine Institute can provide treatment to Medicare enrollees only under private contracts or if Medicare is the secondary insurance.
How did you learn about The Bonati Spine Institute?	*
Would you like The Bonati Spine Institute to verify your insurance coverage?	If "yes" please fill out the form shown below.

Insurance Information

As a service to our potential patients The Bonati Spine Institute will verify all insurance coverage and provide a written summary of your coverage prior to the scheduling of any appointments for treatment. To verify your insurance coverage, we ask that you please provide the following information:

Patient Name:	*
Patient Date of Birth: (mm/dd/yyyy)	*
Primary Insurance
Insured Name: (If other than patient)	*
Insured Date Of Birth: (mm/dd/yyyy)	*
Insurance Company: (Please include state if insurance is Blue Cross / Blue Shield)	*
Insurance State:	*
Insured ID/Policy #:	*
Insured Group #:	*
Insurance Company Phone Number: (Please provide the number on the back of your insurance card.)	*
Secondary Insurance
Select here if you would like to enter secondary insurance information: (If other than patient)
Insured Name: (If other than patient)
Insured Date Of Birth: (mm/dd/yyyy)
Insurance Company: (Please include state if insurance is Blue Cross / Blue Shield)
Insurance State:
Insured ID/Policy #:
Insured Group #:
Insurance Company Phone Number:

By filling out the MRI Request form you acknowledge and agree:

That your personally identifiable health care information can be shared with employees of The Bonati Spine Institute®
That the MRI review is providing only an informational review of the documents that you are providing.
That the written details provided by the Radiologist and Staff Surgeons is not a form of diagnosis. A diagnosis can only be made if you have been physically examined by one of the Physicians and /or Surgeons at The Bonati Spine Institute®.

The Bonati Spine Institute® acknowledges and agrees:
Upon receipt of the MRI Request form it will not share your personally identifiable health care information to third parties without your written consent.

Send your MRI Studies to the address listed below

The Bonati Spine Institute
7315 Hudson Avenue
Hudson, Florida 34667
Attn: MRI Review

Please be sure to include your name, mailing address and telephone number.
To insure that we can track your MRI Review Request properly, please submit the following information. (Please note that The Bonati Spine Institute is not a Medicare provider. We can, however, provide treatment to Medicare enrollees under private contracts or if Medicare is the secondary insurance. Please contact us for more details.)