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Preregistration Forms

Patient Authorization for Release of Film and Documents

Arizona

Phoenix
Solis Women’s Health, BenOra Imaging 1313 E. Osborn Rd. Suite# 213 Phoenix, AZ 85014 Phone: 602-234-2601 Fax: 602-234-3183 Map \| Directions Location Details Click Here for Release Form	Medtech Mammography Centers 18001 N. 79th Ave. Suite# C-54, Glendale, AZ 85308 Phone: 602-866-0503 Fax: 602-866-0528 Map \| Directions Click Here for Release Form	Medtech Mammography Centers 5422 W. Thunderbird Suite# 19C Glendale, AZ 85306 Phone: 602-866-0503 Fax: 602-866-0528 Map \| Directions Click Here for Release Form

Medtech Mammography Centers 4232 E. Cactus Rd. Suite# 214, Phoenix, AZ 85032 Phone: 602-866-0503 Fax: 602-866-0528 Map \| Directions Click Here for Release Form	Medtech Mammography Centers 301 E. Bethany Home Rd. Suite# A119, Phoenix, AZ 85012 Phone: 602-866-0503 Fax: 602-866-0528 Map \| Directions Click Here for Release Form	Medtech Mammography Centers 560 W. Brown Rd. Suite# 1001, Mesa, AZ 85201 Phone: 602-866-0503 Fax: 602-866-0528 Map \| Directions Click Here for Release Form

Medtech Mammography Centers 900 W. Chandler Blvd. Suite# A4, Chandler, AZ 85225 Phone: 602-866-0503 Fax: 602-866-0528 Map \| Directions Click Here for Release Form	Medtech Mammography Centers 13065 W. McDowell Rd. Suite# C-105, Avondale, AZ 85392 Phone: 602-866-0503 Fax: 602-866-0528 Map \| Directions Click Here for Release Form

Tucson
Medtech Mammography Centers 2840 W. Ina Rd, Suite# 144 Tucson, AZ 85741 Phone: 520-546-5599 Fax: 520-546-7507 Map \| Directions Click Here for Release Form	Medtech Mammography Centers 1200 N. El Dorado Place, Suite# H-820 Tucson, AZ 85715 Phone: 520-546-5599 Fax: 520-546-7507 Map \| Directions Click Here for Release Form	Medtech Mammography Centers 910 W. Irvington Suite# 120, Tucson, AZ 85714 Phone: 520-546-5599 Fax: 520-546-7507 Map \| Directions Click Here for Release Form

Indiana

Solis Women’s Health, Indianapolis Breast Center
1950 West 86th Street,
Suite 300
Indianapolis, IN 46260
Phone: 317-872-3583
Toll Free: 800-231-1053
Fax: 317-872-9856
Location Details

Click Here for Release Form

North Carolina

Solis Women’s Health, Bertrand Breast Center
1126 N. Church Street
Suite 103
Greensboro, NC 27401
Phone: 336-379-0941
Toll Free: 866-717-2551
Fax: 336-379-7997
Map | Directions
Location Details

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Texas

Solis Women’s Health of Arlington 300 Arbrook Suite C Arlington, TX 76014 Phone: 817-375-9357 Fax: 817-375-0467 Map \| Directions Location Details Click Here for Release Form	Solis Women’s Health at Denton Regional Medical Center 3537 South I 35E, Suite 211 Denton, TX 76210 Phone: 940-382-5400 Toll Free: 866-717-2551 Fax: 940-382-5477 Map \| Directions Location Details Click Here for Release Form	Solis Women’s Health at Baylor All Saints Hospital 1250 8th Avenue Suite 130 Fort Worth, TX 76104 Phone: 817-886-0880 Toll Free: 866-717-2551 Fax: 817-924-9349 Map \| Directions Location Details Click Here for Release Form

Solis Women’s Health at Harris Methodist Hospital, Fort Worth 800 5th Avenue, Suite 400 Fort Worth, TX 76104 Phone: 817-924-1999 Toll Free: 866-717-2551 Fax: 817-886-0881 Map \| Directions Location Details Click Here for Release Form	Solis Women’s Health of Frisco 5858 Main Street Suite 150 Frisco, TX 75034 Phone: 214-872-4484 Toll Free: 866-717-2551 Fax: 214-705-9240 Map \| Directions Location Details Click Here for Release Form	Solis Women’s Health Lisa Trent Breast Center at Harris Center H.E.B. Harris Center 1615 Hospital Pkwy, Suite 108 Bedford, TX 76022 Phone: 817-857-2800 Toll Free: 866-717-2551 Fax: 817-857-2811 Map \| Directions Location Details Click Here for Release Form

Solis Women’s Health of Central Plano 3801 W. 15th Street, Building C Plano, TX 75075 Phone: 972-596-4033 Toll Free: 866-717-2551 Fax: 972-985-9649 Map \| Directions Location Details Click Here for Release Form	Solis Women’s Health of West Plano 5920 W. Parker Road, Suite 200 Plano, TX 75093 Phone: 972-781-0444 Toll Free: 866-717-2551 Fax: 972-608-4405 Map \| Directions Location Details Click Here for Release Form	Solis Women’s Health of Weatherford 914 Foster Lane Weatherford, TX 76086 817-594-1227 817-594-7326 Map \| Directions Location Details Click Here for Release Form

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