Appointments Request an Appointment "*" indicates required fields First Name*Last Name*Email*Mobile Phone*Date of Birth* Month Day Year Zip Code*Are you the patient?* Yes No What procedure do you need?*Please select an optionMRI without contrastMRI with contrastMRI with and without contrastPET/CT ScanCT Scan without contrastCT Scan with contrastCT Scan with and without contrastArthrogramUltrasoundX-RayMammogramBone DensityEchocardiogramMyelogramNuclear MedicineInterventional Pain ManagementOther ExamIf no, please specify your relationshipIndicate body part for the procedure*How do you intend to pay?*Please select an optionMy employer offers Green Imaging as a benefitSelf-PayOtherPlease provide the name of your employer, insurance or plan name.*Do you have doctor's orders?*Please select an optionYesNoIf Yes, please select one of the following options: Text a photo to (713)524-9190 with your name, DOB, and employer name or have your doctor fax your order to (866)653-0882. If No, please leave instructions in the comment box on how we can help.Questions or comments?Consent By clicking this box, you expressly consent to receive communications from us that may include your personal health information. You may opt out at any time. Δ