Patients > Request an Appointment

Request an Appointment

= Required Field.

Appointment Scheduled by:

Patient
Physician

Patients Name:

Primary Phone # (Home, Work, Cell):

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Secondary Phone # (Home, Work, Cell):

() -

Alternate Phone # (Home, Work, Cell):

() -

1st Choice Preferred Date and Time:

[clear]

2nd Choice Preferred Date and Time:

[clear]

Referring Physician:

Symptoms or Reason for Exam:

Email Address:

Welcome Video Pay My Bill

For your convenience, please use any of the following options to manage your Northwest Radiology Network account.

Pay Bill Online

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To sign up for electronic statements, view your account balance or make online payments, please sign in to the patient account portal.

If you have questions about your account including questions about your statement or insurance coverage, please feel free to chat with us.

317-328-5055 / 1-800-400-9729

For questions about your account or to make payment arrangements, please give us a call.

For additional Northwest Radiology information please contact us.