For more information about scheduling,
please feel free to contact us at any time.

Warwick • Scheduling (401) 921-2900 • Fax (401) 921-2909
Cranston • Scheduling (401) 490-0040 • Fax (401) 490-0049
North Providence • Scheduling (401) 533-9300 • Fax (401) 533-9309
East Providence • Scheduling (401) 431-0080 • Fax (401) 431-0018

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Patient Name: We will contact the patient to complete scheduling for you.			*
Patient Telephone #:			*
Patient DOB:			*
Appointment confirmation requested:			yes no
Method of Confirmation:
Fax Call			E-mail
Reason for Exam:.			*
Special Instructions: .
Referring Physician:			*
CC to:
Reports:	Call Report Fax Report Mail Report E-mail Report		Images:	CD to Patient CD to Physician Film to Patient Film to Physician
.

Brain	Abdomen	MRA Brain
Brain w/orbits (MS eval.)	MRCP	MRA Neck
Neck (soft tissue)	Pelvis	MRA Brain & Neck
C - Spine	Shoulder L R	3D Reconstruction
T - Spine	Knee L R
L - Spine	MR Arthrogram
Other MRI
Other MRA
Head	Abd/Pelvis	CT Enterography - Abd/Pelvis
Paransal Sinuses	Renal (mass) - Abd/Pelvis w/ & w/o contrast and 3D Reconstruction
IAC/Middle Ear		C-Spine w/3D
Neck (soft tissue)		T-Spine w/3D
Chest (routine)	CT Urogram (calculus) Abd/Pelvis w/o contrast	L-Spine w/3D
Chest (high res for ILD.)
Other 3D Reconstruction
Other CT
Other CTA
Abdomen w/Doppler	OB 1st Trimester	Breast
Renal & Bladder (w/Doppler as needed)	OB 2nd/3rd Trimester	L R Bil.
	Thyroid	DVT
Pelvis (w/transvaginal as needed)	Carotid	L R Bil.
	Scrotum (w/Doppler as needed)
Aorta w/Doppler
Other Ultrasound
Other Doppler
Sinuses	T - Spine	Multi. Abd.
Chest	L - Spine	Pelvis
C - Spine	KUB	IVP
Other
Screening Mammography	Diagnostic Mammography Left Right Bilateral
DEXA (bone densitometry)
*Denotes required field.
Patient Instructions are available here.