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Bone Health Program

 Bone Health Program
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Flower 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. 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 617-730-0585.

DXA Requisition Form
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