Radiology Appointment Request Form

Complete the information below to request an appointment. We'll review your request and respond within three business days.

If you prefer to contact us directly to schedule an appointment please call: Norwalk: 203-838-4886, option 1 or Danbury/New Milford: 203-739-4999.

If this is an emergency, please call 911.

Name:

Send request to:

Who is the ordering doctor?

We will provide you with the first available appointment. If you prefer a specific date range, please specify.

Which day do you prefer?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

What is your preferred time?

Radiology test ordered and reason for exam

Someone from scheduling will reach out regarding this appointment within three business days. Please provide your preferred contact number.