Request An Appointment

Submit the form below or call your local center to discuss appointment options.

First Name(Required)

Last Name(Required)

Email Address(Required)

Phone Number(Required)

Location(Required)

Type of Imaging Scan(Required)

Date Of Birth(Required)

Do you have a doctor's order for imaging?

Yes

Email Acknowledgement(Required)

I Agree

I understand Gateway Diagnostic Imaging cannot guarantee privacy for e‐mail communications over the internet, other than website submissions from a patient portal. I understand and accept this risk, and thus, will allow Gateway Diagnostic Imaging to communicate my protected health information using my personal email address listed above for the purposes of scheduling an appointment.

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