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Outpatient Imaging Request Form

Imaging Modality
Contrast Injection Required
CBC & Chemistry completed
Chest rads performed?
Upload X-Ray Here
Upload supported file (Max 15MB)
Upload Additional X-Ray Here
Upload supported file (Max 15MB)
Upload Medical Records Here
Upload supported file (Max 15MB)
Upload Bloodwork Results Here
Upload supported file (Max 15MB)
Pre-anesthetic meds dispensed

*Please contact the VSCAN if you have questions or need further guidance on our recommended PVPs.

Typical turnaround time for interpretation is 24 business hours. Should you require more urgent interpretation; please contact us prior to the appointment so that we can make the necessary arrangements.

Thank you for requesting an outpatient imaging study with the VSCAN!

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