Make An Appointment | Highway Imaging Associates

Thu, 06/04/2009 - 13:20 — admin

A Highway Imaging Associates professional scheduler will contact you the next business day** to schedule an appointment. If you would prefer to call us, please dial the individual center of your choice, and we will be glad to assist you. Please fill out the information below and a scheduler will contact you shortly.

Do you have a written requisition from your doctor for the imaging procedure you would like to schedule?: *

yes

Please note: We can not perform a diagnostic imaging procedure without a written requisition from your referring physician. Please contact your referring physician's office to obtain the proper requisition.

Patient Information

First Name: *

Last Name: *

Date of Birth: *

Home Phone: *

Alternate Phone:

Contact Email: *

I prefer to be contacted by: *

Imaging Procedure

Referring Physician:

Type of Procedure:

** Scheduling department hours are Monday through Friday, from 7 a.m. to 6 p.m

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