Submitting an order to DIS is very easy. Follow the simple steps below.

1. Create your referral order.
2. Save it as an electronic PDF file or scan to create an electronic document.
3. Click “Choose File” to attach the order.
4. If you would like, please fill in as many fields as possible and attach additional documents to assist us in expediting the scheduling process.
5. Click SUBMIT.

Thank you for choosing DIS: Doctor trusted, patient preferred.

  • Accepted file types: jpg, gif, png, pdf.
  • If a code is used and marked with a "*", CMS recommends considering a code with a greater degree of specificity.
  • Accepted file types: jpg, gif, png, pdf.
  • Accepted file types: jpg, gif, png, pdf.
  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.