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 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

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

Last Revised: October 20, 2016