Thank you for submitting an online request to make an appointment. In order to have an exam, you must have a health care provider’s referral order.
If your referral order is for an x-ray, you do not need to make a scheduled appointment. Come to our facilities performing x-ray during our operating hours and we will accommodate you on a walk-in basis.
Please complete as thoroughly as possible. While insurance information is not required, providing it will assist us in facilitating our response back to you.
Fields marked with an asterisk are required fields and need to be completed in order to send your request to DIS.