SCHEDULING AN APPOINTMENT
We make it easy!  Health Scan Imaging provides simple and flexible scheduling options that are convenient for you.  Even early evening and Saturday appointments are available. You can request preferred appointment times by completing the brief electronic scheduling form below.  Our courteous staff will respond promptly with a telephone call to confirm your appointment.  We will also provide complimentary transportation, if desired.

Thank you in advance for your trust and confidence in our services.

TITLE:  Dr.    Mrs.    Mr.   Ms.

NAME:

LAST:
FIRST:
MIDDLE:

 

ADDRESS:
CITY:
STATE:
ZIP:

Daytime Phone: 

Evening Phone:    

E-mail: 

1st Examination
Examination Requested:  

2^nd Examination
Examination Requested:  

3^rd Examination
Examination Requested:  

Desired Date: 

Desired Time:  
Morning   Afternoon   Early Evening

How did you learn about Health Scan Imaging?
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Our Website      Billboard 
Other

Questions or Comments: