(973) 720-0050
Schedule Appointment
Home
About Us
Services
3T Wide Bore MRI
Open MRI
CT Scan
Breast Imaging
Ultrasound
X-rays
Bone Density/DEXA
Echocardiogram
Elastography Ultrasound (Fibroscan)
Pay Online
For Providers
For Patients
New Patient Registration
CT Questionaire
Ultra Sound
Mammography
Dexa
Contact us
Search for:
Dexa
Home
Dexa
Name
*
Date
Sex:
Male
Female
Date of Birth
Ethnic Origin
African-American
White, Caucasian
Hispanic
Asian
Current Height
Current Weight
Have you entered menopause?
Yes
No
If yes, age?
*
Gynecological History
Have you had your ovaries removed?
Yes
No
Have you had a hysterectomy?
Yes
No
Absence of menstruations?
Yes
No
Do you take hormone therapy in any form at this time?
Yes
No
If so, what type?
*
Premarin
Estrogen
Birth Control
Medical History
Have you ever had a Bone Density (DEXA) scan before?
If so, when?
*
Where?
*
Do you have a family history of Osteoporosis?
Yes
No
Have you taken Cortisone or Prednisone orally for over 3 months?
Yes
No
Do you take any medication for raising bone density?
Fosamax/Alendronate
Fosamax D
Boniva
Actonel
Evista
Zometa
Reclast
If so, how long?
*
Do you take supplemental calcium?
1000 mg
500 mg
None
Do you take supplemental vitamin D?
Yes
No
If so, How much?
*
Have you had hip replacement surgery?
Yes
No
Have you had surgery on your lower back?
Yes
No
Other Medical conditions: (Check all that apply)
Personal history of Osteoporosis
Kidney disease
Hyperthyroid (overactive thyroid)
Parathyroid disorder
Hypothyroid (underactive thyroid)
Rheumatoid arthritis
Eating Disorder (anorexia/bulimia)
Asthma
Celiac Disease
Hypothalamic amenorrhea
Chronic steroid us, type and duration:
Send Message
Please do not fill in this field.
