• 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 information provided by our Physicians is not a form of diagnosis. A diagnosis can only be made if you have been physically examined by one of the Physicians at The Bonati Spine Institute®.
Upon receipt of the MRI submission form it will not share your personally identifiable health care information to third parties without your written consent.
The Bonati Spine Institute
7315 Hudson Avenue
Hudson, Florida 34667
Attn: MRI Review
To insure that we can track your MRI Review submission properly, please submit the following information.