Our Hamilton and Lawrenceville locations accept walk-in x-ray patients. Walk-in hours can be found on our locations page.

Patient Information

*First Name
*Last Name
*Phone Number
*Email
*Gender malefemale
*Date of Birth

Under Age Agreement

Based on your answer for the patient's Date of Birth, you have indicated that you or the patient is not an adult (18 years of age or older). A parent or guardian will need to be present with you or the patient at the time of the requested appointment. Please indicate you understand our Under Age Agreement by providing your answer below.

Under Age Agreement* I agreeI do not agree

Referring Physician Information

Calcium Score Patients – a prescription from your physician is not required for this exam.

 

*Referring Physician
Upload Prescription
(acceptable file types are pdf, png, jpg or jpeg)

Email Prescription (If file is too large to upload.)

Insurance Information

*Insurance Provider
*Policy Number

Appointment Information

At this time certain procedures are only available at select locations. Please view them below.

 

Hamilton Facility	Lawrenceville Facility
Urogram	Calcium Scoring
Extremity MRI	Breast MRI

 

*Requested Location Please select oneHamiltonLawrenceville
*Requested Date
*Preferred Time Please select oneMorningAfternoonEvening

Procedure Information

*Requested Procedure Please select oneMRI/MRABreast MRIExtremity MRIBone Density (Dexa)Calcium ScoringCAT ScanCT Lung Cancer ScreeningCTADental ScanMR ArthrogramUrogramMammographyUltrasoundUltrasound Guided Biopsy/AspirationX-Ray

Body Part (For an MRI/MRA, Extremity MRI, CAT scans, CTA, Arthogram and Ultrasound let us know the specific body part for the procedure.)
Any additional information you need to provide?

Request Appointment