Request an Appointment

Patient Information

First name

Last name

Email address

Phone number

I'm already a patient

Preferred Date*

Monday to Friday, excluding holidays.

Preferred Time*

Appointments available 9 a.m. to 5 p.m.

Do you have?

Cardiac Pacemaker or Defibrillator

Aneurysm Clip(s)

Cochlear Implant

Metal dental braces, plates, pins, screws, or surgical staples

Bullet or shrapnel in your body

Intrauterine Device (IUD)

Additional information

If there's anything else that you would like me to know prior to your appointment, please include it here.

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* Scheduling: A representative will contact you within 24 hours to complete and confirm your appointment.

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