Physician Referrals

Mid-Delaware Imaging requires a written order for all imaging studies to ensure we perform the proper exam to suit your patient's needs. In addition, this extra measure makes certain that MDI distributes the interpretation to the appropriate referring physician responsible for the patient’s follow-up care. If a patient does not present with a written order, we will contact you to obtain confirmation of the study prior to initiating any patient care.

MDI has a number of pre-printed referral forms for you to use as needed. These forms capture the critical information MDI needs in order to know precisely what type of study should be performed. We also ask for a few comments about the patient’s history so that we can tailor the exam to the patient’s exact medical needs. If you prefer to use your own forms, MDI will accept any referring prescription which contains the following required fields: patient name, physician signature, date, type of exam, and patient history.

To request forms, email: or call us at 320-734-9888. MDI offers the following materials for your use:

  • Referral Forms (pad of 50)
  • Informational Brochures
  • Breast Self-Exam Cards
  • Insurance Participation List