Desert Imaging
Online Request

Dear patient,

To submit an exam request, please complete the form below as completely as possible and press the “Submit” button. A Patient Support Specialist will call you in 1-2 business days to confirm your preferred date, time, and location.
Please note the following:

• This form is to submit a request for an exam; the date, time and location of the exam is not confirmed until a Patient Support Specialist contacts you.

• You must have a medical provider’s referral to receive a medical imaging exam.

• Fields marked with an asterisk (*) below are required.

• A confirmation message will appear once the Exam Request Form is submitted correctly.

Thank you for choosing Desert Imaging!

Please provide your personal information.

Please provide the information about your referred physician:

Please note that we will schedule your service(s) for the date and time closest to your preferences.