Diagnostic Imaging Services offers online registration, enabling you to fill out personal and medical information before your visit.  It saves you time, making the day of your visit that much easier.

Please complete as thoroughly as possible.  This will assist us in facilitating your registration process.  You will be given a chance to review this information, and make additions or corrections, at the time of your appointment.

PLEASE NOTE: If this will be your first visit to DIS as a new patient, please schedule your appointment first with us and then submit your online registration information.

Mandatory fields that DIS needs to be completed are indicated by an asterisk. Please also indicate your exam type, DIS location and date of your visit, found on the bottom of this form.

Thank you.