Scheduling and Forms

Scheduling
A physician referral is required for most imaging exams and procedures. Please contact your primary care physician or, for referral to a physician, call 972-747-1000 or 1-877-THR-WELL (1-877-847-9355).

A routine screening mammogram does not require a physician referral, unless you have breast implants. To schedule your mammogram, call 972-747-6000.

Physicians
After making a referral for an imaging exam, referring physicians may provide their patients with appropriate scheduling and order forms. Please ask patients to bring the forms to their appointment.

Patients
Patients who did not receive scheduling and order forms from their referring physician are asked to print and bring them to their scheduled appointment. This will help to make your visit as smooth as possible.

Order Forms

• Patient Order Form (needed for all outpatient exams)

Screening Forms

• Contrast Injection Screening Form (needed for CT and MRI exams with Contrast)
• MR Screening Form (needed for all MRI exams)
• Radiology Pregnancy Screening Questionnaire
• Authorization for Release of Patient Films and Images

Learn What to Expect

• Barium Enema Examination - examination of the large bowel or colon
• Hysterosalpingography (HSG) - X-ray examination of the uterus and fallopian tubes
• Intravenous Pyelogram - X-ray examination of the urinary tract
• Lumbar Puncture - An x-ray examination where fluid is taken from the spinal column then tested for various conditions
• Myelogram - X-ray examination of the structures within the spinal column
• Pregnancy and Diagnostic X-ray/CT Safety - Information about radiation protection, safety and patient care during pregnancy
• Upper GI Series - Radiographic examination that produces x-rays of your upper gastrointestinal tract

Appointments
To schedule an appointment or for more information, please call 972-747-6141.

Hours
X-ray examinations: 8 a.m. to 5:30 p.m., Monday through Friday
Other procedures: hours vary based on specific procedure