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  • MRI
  • CT SCAN
  • X-RAY
  • MAMMOGRAM
  • ULTRASOUND
  • PET/CT
  • NUCLEAR
1: Type / Click Above to Select Procedure
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2: Enter Details

Need study performed by
Requesting for
Patient First Name
Patient Last Name
Patient Date of Birth
Patient Phone (mobile preferred)
Extn
Patient Email (optional)
Requested By
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Referring Doctor (First & Last Name)
Message [256 char] (optional)

3: Select Location

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*Patient CANNOT have an MRI if they have any of the following : Pacemaker, Defibrillator, Stimulator , Implanted Medication Pump , Brain Aneurysm Clip, Metal Fragments in the Eyes, Braces, IUD, Extenders   

**Patient CANNOT have a IV contrast CT study without proper allergy protocol if they have an Allergy to Iodine