*Please indicate the start date of all cardiac medications.
6 radiographs maxAdditional fee appliesMust be sent in dicom format to our serverRadiographs older than 2 weeks will not be accepted
If you anticipate your patient needing fine needle aspirates, please obtain consent prior to scan, as well as permission to sedate if needed.
When you submit this form, you will be emailed a copy of the information you submitted. You can print that email for your records.