Request an Appointment | RAI Diagnostic Imaging Centers

Our Hamilton and Lawrenceville locations accept walk-in x-ray patients. Due to COVID-19 all patients must wear a face mask and will be screened at time of arrival. Patients may be asked to return to their car until a study time is available. Walk-in hours can be found on our locations page

Patient Information

First Name*

Last Name*

Phone*

Email*

Gender* Male Female

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 agee I do not agree

Ref. Physician Information

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

Referring Physician*

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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
Barium Enema	Calcium Scoring
Urogram	Open MRI
Extremity MRI	Breast MRI

Requested Location*

Requested Date*

Preferred Time*

Procedure Information

Requested Procedure*

Body Part AC [Acromioclavicular] joints w & w/o weight
Abdomen
Abdomen [KUB]
Ankle
Bone (skeletal) Survey
Bone Age
Bone length study/Scanogram
Cervical spine
Chest
Clavicle
Elbow
Facial Bones
Femur
Fingers
Foot
Forearm
Hand
Hip
Humerus
Knee
Lumbar Spine
Mandible
Mastoids
Nasal Bones
Neck
Obstructive Series
Orbits
Os Calcis / Heel
Other
Pelvis
Ribs
Sacroiliac joints
Sacrum and Coccyx
Scapula
Scoliosis Survey
Sella Turcica
Shoulder
Sinuses
Skull
Soft Tissue
Sterno-clavicular joints
Sternum
T-M Joints
Thoracic Spine
Thoracolumbar spine
Tibia & Fibula
Toes
Wrist

Body Part Abdomen
Cervical Spine
Chest
Head
Kidney/ Renal
Lower Extremity - femur/tibia-fibula
Lumbar Spine
Maxillofacial Area
Orbits-Sella-Inner Ear (IACs)
Other
Pelvis
Sinuses
Soft Tissue Neck
Thoracic Spine
Upper Extremity - humerus/arm
Urogram

Body Part CTA Abdomen
CTA Aorta-Iliofemoral [run off]
CTA Chest
CTA Head
CTA Lower Extremity
CTA Neck (Carotids)
Kidney/ Renal
CTA Pelvis
CTA Upper Extremity

Body Part Hand
Wrist
Elbow
Knee
Ankle
Fingers
Toes

Barium Study Type Esophagram
Small bowel series
Upper GI
Upper GI w/ Small bowel series

Digital Mammo Type Bilateral Screening
Bilateral Diagnostic
Unilateral (Left)
Unilateral (Right)

Body Part Ankle
Elbow
Hip
Knee
Shoulder
Wrist

Body Part Abdomen
Ankle
Brain
Cervical Spine
Chest (Mediastinum)
Chest Angiography
Elbow
Face
Foot
Hand
Hip
Liver
Lumbar Spine
MRA Head
MRA Lower Extremity
MRA Neck
MRA Pelvis
MRA Spine
MRA Upper Extremity
MRA abdomen
MRCP
Neck or IAC's
Orbits
Other
Pancreas
Pelvis
Shoulder
TMJ's
Thoracic Spine
Wrist

Body Part Abdomen
Abdomen - complete
Aorta / IVC's
Breast
Carotid Bilateral
Chest
Gall Bladder
Head/Neck (thyroid)
Liver
OB / Pregnancy < 7 weeks
OB / Pregnancy > 7weeks
Other
Pancreas
Pelvis / transvaginal
Pelvis, transabdominal, and transvaginal
Pelvis/ transabdominal
Renal / Kidney
Renal Bladder
Scrotum/Testicles
Venous lower extremity DVT
Venous lower extremity Reflux stud
Venous upper extremity DVT

Ultrasound Guided Biopsy Type Breast
Other
Thyroid

Do you wish to schedule another procedure?* Yes No

Additional Requested Procedure*

Body Part Abdomen
Cervical Spine
Chest
Head
Kidney/Renal
Lower Extremity - femur/tibia-fibula
Lumbar Spine
Maxillofacial Area
Orbits-Sella-Inner Ear (IACs)
Other
Pelvis
Sinuses
Soft Tissue Neck
Thoracic Spine
Upper Extremity - humerus/arm
Urogram

Body Part CTA Abdomen
CTA Aorta-Iliofemoral [run off]
CTA Chest
CTA Head
CTA Lower Extremity
CTA Neck (Carotids)
Kidney/ Renal
CTA Pelvis
CTA Upper Extremity

Body Part Hand
Wrist
Elbow
Knee
Ankle
Fingers
Toes

Barium Study Type Esophagram
Small bowel series
Upper GI
Upper GI w/ Small bowel series

Digital Mammo Type Bilateral Screening
Bilateral Diagnostic
Unilateral (Left)
Unilateral (Right)

Body Part Ankle
Elbow
Hip
Knee
Shoulder
Wrist

Ultrasound Guided Biopsy Type Breast
Other
Thyroid

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