• CT or CAT Scan
• General Radiology
• Interventional Radiology (Angiography)
• MRI
• Nuclear Medicine
• PACS System - Physician Connectivity
• Pediatric Imaging Services
• Request Your Films
• Ultrasound
• Women's Imaging Services

Radiology Appointment Request

You may schedule your appointment online using this form for mammograms, ultrasounds, CT scans and all other radiology procedures. If you have any questions, or if you are having trouble with this form or would like to schedule your appointment via the phone please call (480) 882-4703. Thank you.

First Name
Last Name
Address
City
State		ArizonaAlabama Alaska American Samoa Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Zip
Email
Phone Number
Did a physician refer you here?			Yes		No
Primary Care Physician
Employer
Is your health insurance through your employer?				Yes		No
Insurance Carrier
Insurance ID Number
Date of Birth (e.g. 03-17-1976)
Gender		Male		Female
Procedure Required
Diagnosis
Campus		Osborn		Shea		Thompson Peak
Reason for Exam
Appointment Date Preference
Preference 1:			Preference 2:			Preference 3:
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