Thank you for submitting an online request to make an appointment. In order to have your exam, you must have a medical provider's referral order.
Please complete as thoroughly as possible. While insurance information is not required, providing it will assist us in facilitating our response back to you. Fields marked with an asterisk are required fields and need to be completed in order to send your request to Capitol Imaging Services (CIS). Once your request is received, a CIS associate will contact you at the phone number(s) provided to arrange a visit.
When speaking with our associate, we encourage you to give permission for CIS to use your email address to send you an appointment confirmation notice. The notice can be very helpful to you in remembering your upcoming visit.
We will see you soon. Thank you.