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Office Hours: 8:30 AM to 5:30 PM Monday through Friday
3T Radiology & Research offers patients and referrers around the clock scheduling access
3T Radiology provides transaparent, flexible and affordable self-pay options.
* First Name:

* Last Name:

* Phone:

* Date of Birth:

* Email:

* Exam(s) Requested:
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( THE AREA OF CONCERN MUST BE SPECIFIED HERE IN ORDER FOR US TO ACCURATELY SCHEDULE YOU. )

*

* Area of Concern:

Laterality

* Diagnosis: ( If unknown, please list "unknown" )

* Primary Insurance Information: ( If none, please list "none" )

* Primary Insurance Member ID: ( If none, please list "none" )

* Secondary Insurance Information: ( If none, please list "none" )

* Secondary Insurance Member ID: ( If none, please list "none" )

* Referring Physician:
* Name: