Request an Appointment

Please tell us who you are and give us a way to contact you:

Person to Contact:

Your e-mail address:

Your phone number: (ex: 239-000-0000)

First Name: Last Name:

Relationship to Patient:

Patient Information:

*First Name: *Last Name:

*Date of Birth: (ex: 09/09/1999)

*Daytime Phone # (ex:239-000-0000) Evening Phone# (ex:239-000-0000)

Appointment Information:

*Referring Physician:

*Diagnosis (Reason for Study):

*Study or Studies Requested:

Preferred Appointment Day: (select all that apply)

Monday Tuesday Wednesday Thursday Friday Saturday (MRI Only)

Preferable Appointment Time:

*Please note: Some appointment times/days are not available at all offices and in all modalities.

Please select the location you would like to be seen at:

600 Tarpon Bay Road, Sanibel (US, X-Ray)
63 Barkley Circle, Suites 100 & 101, Fort Myers (MRI, US, CT, X-Ray(Diagnostic & Fluoroscopy)
6311 South Pointe Boulevard, Suite 600, Fort Myers (MRI, US, CT, X-Ray, Nuclear Medicine, DEXA)

Comments:

You will be contacted by one of our friendly and knowledgeable schedulers during normal business hours, Monday through Friday 7:30AM-5PM. If you need to speak with someone right away, please call the scheduling department directly at 239-938-3535.