Bone Health Program
DXA request form
The Dual Energy X-Ray Absorptiometry (DXA) Request Form has to be completed thoroughly by the primary care provider or the referring doctor who is requesting a bone density test on their patient. The DXA requisition is used by a doctor specializing in bone health and the technologists to help identify which skeletal scan sites will be scanned for a patient.
This test can not be performed without a DXA requisition. The order can be completed in Power charts or you can fax over this requisition. We will have to cancel the patient appointment within 24 hours if the requisition is not received prior to that date. Our fax number is 617-730-0897.
