Telemedicine Referral Consultation

  • Please complete this form to request a virtual doctor consultation. A licensed doctor will review the information and call you at the phone number entered for the medical consultation within a few hours.
  • AffordableScan partners with a leading independent telemedicine provider to offer this service. Providers are not employed by AffordableScan and this services abides by all HIPPA regulations.
  • Once a consultation is completed any referral orders are directly sent to AffordableScan, so we can assist you with scheduling of the imaging scan. We will contact you as soon we receive it and we can also send you a copy if you are interested.

I. Patient Information

0 / 25
0 / 25
0 / 25
0 / 10
Secured request


  • How does the Referral Telemedicine Consultation work? Our partner virtual medical consultation service is a simple, affordable solution for anyone that needs a physician order for an imaging scan.
  • What is the cost of the RX Telemedicine Consultation? The all inclusive fee is $40.
  • Am I guaranteed to receive a doctor referral for my scan? No. Providers only write orders for what they deem medically appropriate.
  • Can I use this an emergency consult? No. Usually we receive the referral in 4-8 business hours, but this turnaround time is not guaranteed. You should NOT use this service if you are experiencing a medical emergency or if you have any pressing time commitment matter. Please call 911 immediately.
  • Does this service offer refunds? No, a licensed doctor spends time reviewing each case in detail even if a referral is not deemed medically appropriate, so unfortunately the provider does not offer refunds.
  • Can I use this service for a follow-up conversation with the telemedicine provider? Yes, but this requires a separate payment of $29.