Appointments Request an Appointment "*" indicates required fields First Name* Last Name* Email* Mobile Phone* Preferred Method of Contact Call Text Email Date of Birth* Month Day Year Zip Code* Are you the patient?* Yes No If no, please specify your relationship 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 ExamIndicate body part for the procedure* How do you intend to pay?*Please select an optionMy employer offers Green Imaging as a benefitTraditional InsuranceUninsured/High Deductible Self-PayOtherPlease list your employer* Upload Doctor's OrdersPlease note that this file is not required; however, it is highly recommended in order to speed up your appointment process. Drop files here or Select files Max. file size: 50 MB. Upload Benefits CardPlease note that this file is not required; however, it is highly recommended in order to speed up your appointment process. Drop files here or Select files Max. file size: 50 MB. 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