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Request a Diagnostic X-Ray

If your doctor or provider has ordered a diagnostic x-ray, please use the form below to schedule your exam.

About x-ray: X-ray imaging is used for diagnosing various medical problems in bones, chest, intestines and for other specialized needs. X-rays are the most frequently-used form of medical imaging.

X-ray Guidelines

X-rays require a physician's order
Your doctor may place this order electronically, or will provide a paper order form that you should bring with you to your appointment
If you are pregnant or may be pregnant, please tell your doctor or technologist before you have an x-ray

First Name:

Last Name:

Email:

Phone:

Date of Birth:

Ordering Physician:

Is the ordering physician a Ferrell physician?:

YesNo

Do you have a printed order from a physician?:

YesNo

Preferred date:

Preferred Time:

Preferred Location: