We serve the community
through compassionate patient care
and quality diagnostic imaging
Home
Patient Information
Physician Referral
Location
Contact Us
Requisition Form
*
indicates required field.
OHIP #
*
V.C .
*
Patient Name
*
Tel
D.O.B
*
Gender
M
F
Your Appointment
Physician Name
*
Provider Number
*
Clinical Information
CARDIAC IMAGING
Exercise Stress MPI
Persantine Stress MPI
Rest Thallium
Rest Muga
Patient
Height
Weight
GENERAL IMAGING
BONE
Total Body
Specific Site
Bone Mineral Density
Osteoporosis Detection (BMD)
RENAL
DTPA Renal
With Captopril
With LASIX
THYROID
Thyroid Uptake & Scan
Thyroid Scan Only
Uptake Scan Only
ABDOMEN
Liver/Spleen SPECT
RBC Liver SPECT
Gallblader/Biliary
