Please complete the form below and a scheduler will contact you within 24 hours to confirm your appointment.
If you would like immediate assistance, please call
option 2, Mon. - Fri., 8 am - 5 pm.
No appointments are necessary for general diagnostic X-rays such as chest, spine, sinuses, extremities, ribs, etc.
Appointment Request Form
Appointment Requested by:
Date of Birth:
Primary Phone Number:
Secondary Phone Number:
Alternate Phone Number:
1st Choice Preferred Date:
2nd Choice Preferred Date:
Preferred Time for Appointment:
Preferred Method of Contact:
-- Select A Contact Method --
Primary Phone Number
Secondary Phone Number
Alternate Phone Number
-- Select A Location --
10603 North Meridian Street Imaging Center
Naab Road Imaging Center
Meridian North Imaging Center
Type of Procedure:
-- Select A Procedure --
Bone Density/Osteoporosis Study, DEXA
Symptoms or Reason for Exam:
Please let us know if you have had previous mammography elsewhere.
If you can bring these films with you, this would be very helpful. Otherwise, we will be happy to request the outside mammogram by mail delivery.
If you need to cancel your appointment, we would greatly appreciate if you would provide 24 hours notice.
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