Radiology Imaging Services Forms

To schedule an appointment, please call Centralized Scheduling at 574.647.7700. Fax orders to 574.647.2200.

• Radiology Order Form (PDF)
• Exam Preps and Directions to the Facility(PDF)
• PET/CT Prep Instructions (PPT)
• PET/CT Order Form (PDF)

Services included in this order form are:

• CT/CTA
• GI/GU
• Mammography
• Nuclear Medicine
• Ultrasound
• X-Ray