Below you will find information to help make your visit to PPMI quick and easy!

Preparation for your appointment

Patient information form in English

Formulario de información del paciente en Español

If you have been referred to Park Place Medical Imaging, PC for radiology services please make sure you bring the information we will need to properly process your claim with your insurance company or Worker's Comp policy.  The Patient Information forms below (available in English and Spanish) must either be printed and filled out ahead of time or completed when you arrive for your appointment.  Please note:


  • All Worker's Comp claims require that you provide your Social Security Number.  If you do not wish to provide this info, you can elect to pay cash for the visit.

  • If your visit is covered by Worker's Comp please make sure you have your Claim # and employer information.

  • If you have any questions about whether your visit is covered by insurance, please feel free to call the office (212) 380-2075.