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Most laboratory testing and X-rays do not need to be scheduled. Walk ins can be accommodated.

Only these laboratory and x-ray tests MUST be scheduled due to the process involved:

  • Glucose Tolerance test
  • Therapeutic Phlebotomy
  • X-rays that require a fluoro injections
Please complete the form below to schedule:
  • CT scans
  • MRI (Magnetic Resonance Imaging)
  • Ultrasounds
  • Nuclear Medicine Imaging
  • Outpatient Rehab (occupational, physical and speech therapy)
  • Family Birthplace Perinatal Testing
  • Pulmonary Function Testing and Blood Gases
  • Vascular Ultrasound

Scheduling Request Form

First Name Last Name MI



Daytime Phone                                   Evening Phone     
Date of Birth        
                             
SS # (Last 4)          
Best time to reach you?   

Where would you like to have your test?     
     
When would you like to have your test done?
First Choice Second Choice Third Choice





Ordering Physician (First & Last Name)

Type of Test

Diagnosis (reason for test or procedure)