BAMF Health Patient Inquiry

BAMF Health Patient Inquiry

Please use the form below to request more information from our team at BAMF Health

Please select your area of interest:*

Select

Alzheimer's Disease

BAMF Health offers Amyloid imaging for Alzheimer’s with necessary follow up MR’s for all indications as determined by your doctor. Amyloid PET scanning can be obtained at BAMF Health’s Molecular Imaging Clinic through a doctor’s order.

Please work with your doctor directly to obtain an order. Your provider can order a PET/CT or PET/MR scan by using our forms. Please click here to download the forms.

Clinical Trials

Please visit BAMF Health Clinic Trials for a full list of trials we are actively enrolling for.

If you would like to receive updates when BAMF Health initiates a clinical trial that matches your interests, please click here to fill out the interest form.

Please note - once our team receives your interest form, you may not be contacted until a trial matching your diagnosis is available.

Please enter your name (Last Name, First Name)*

Please format name as shown above

What state do you live in?*

Select

What country do you reside?

If non-US resident

Is English the Primary Language Spoken in your Home?*

YES

Please enter your preferred language (if NOT English)

Date of Birth (MM/DD/YYYY)*

Email Address

*If you do not have an email, please be sure to enter a phone number to ensure our BAMF Health team can contact you*

Primary Phone Number*

Phone

Street Address*

Street Address Line 2

(if applicable)

City, State Zipcode*

Please format as shown above

Primary Insurance Provider*

If none please enter "Self Pay" into this field

Secondary Insurance Provider

Year of Diagnosis

Additional information

Our clinical care team will be able to best serve you when they have as much information as possible. Please provide an overview of the care you have already undergone for this illness or condition.

Scanning

If your doctor has told you that you need a scan, ask them to consider ordering it at BAMF Health. Results from the scan will be sent back to your provider. In most cases, scans can be obtained the same week we receive the order and approval.

Please work with your doctor directly to obtain an order. Your provider can order a PET/CT, CT, PET/MR, or MR scan by using our forms. Please click here to download the forms.

Doctors should fax the order form directly to BAMF Health at 616-282-2042

Send me a copy of my responses

Privacy Notice|Report Abuse