Appointment request

  1. 1
    Fill out the form below with your personal information.
  2. 2
    Choose the type of scan you want.
  3. 3
    Choose a clinic from the ones that are suggested.
  4. 4
    Send your request for appointment.

Send your form

Attach your file (request, prescription or other)
( .pdf, .doc, docx, .rtf, .png, .jpg .gif, .tif )