Schedule MRI, CT Scan, Online at Arkansas Medical Imaging

MRI
CT SCAN
X-RAY
MAMMOGRAM
ULTRASOUND
PET/CT
NUCLEAR

Click For Special Requests

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

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

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Facility Fax:	{{ pav.pages.locappreq.model.details.content.faxNumber }} {{ pav.pages.locappreq.model.details.info.selectedLocation.faxNumber }}
Patient Name:	{{ pav.pages.locappreq.model.details.info.reqForFirstName }} {{pav.pages.locappreq.model.details.info.reqForLastName}}
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Doctor's Office - Please fax the script, demographic page and other necessary information directly to the imaging center.

Patient - Please fax or bring the original note from the referring doctor to the imaging center.

Click Here - Gateway New Appointment Scheduler Referring doctors click here for Gateway New Appointment Scheduler

1: Type / Click Above to Select Procedure

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

Referring Doctor (First & Last Name)

Message [256 char] (optional)

3: Select Location

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Click Here - Gateway New Appointment Scheduler Referring doctors click here for Gateway New Appointment Scheduler

1: Type / Click Above to Select Procedure

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

Referring Doctor (First & Last Name)

Message [256 char] (optional)

3: Select Location

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Summary of Appointment request

Procedure

CPT Code:

Referring Doctor:

Need By:

Facility Name:

Facility Address:

Facility Phone:

Facility Fax:

Patient Name:

Request Confirmation:

An email has been sent to patient at

Facility will call patient at

Facility will call patient at

Message