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Patient Forms

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at You may bring or mail your completed forms to the office at the time of your visit.


Chambersburg Imaging Associates participates with the following insurance plans:

  • HGS Administrators (Medicare)
  • PA Blue Shield
  • Capital Blue Cross
  • Carefirst
  • Mailhandlers
  • Aetna PA Medicaid
  • Unison
  • Gateway
  • Devon
  • Tricare
  • Railroad Medicare

If you have a question about an insurance related matter, please contact our office directly.