Submit your completed Advisory Committee on Diagnostic Services' Application

Below is the secure upload tool for submitting a completed Advisory Committee on Diagnostic Services' application form.

Please ensure that your form is complete and fully authorized prior to submitting. Only complete and authorized applications can be processed.

Note: This secure upload tool is for submitting an application, or related items, to the Advisory Committee on Diagnostic Services. If you are looking to submit and Assignment of Payment form, click here.

If you have questions related to completing an application, contact Diagnostic Facilities Administration at

To submit a completed, authorized application form:

  1. Print/scan the completed application and save a digital copy to your computer

  2. Complete all contact information fields below

  3. Click "Browse" and locate the scanned form on your computer

  4. Submit form

Note: Please scan all application documents together, creating a single pdf file prior to submission. The upload tool can only accept 1 (one) pdf per submission.

To report any issues with the upload tool, please email:

Last Revised: March 13, 2020