Request an Appointment

This online appointment request form may be used to notify Washington Radiology that you would like to schedule a non-urgent appointment. Please note that information submitted on this form may not be secure or confidential.

To ensure the accuracy and completeness of your request, please have the order from your physician and your insurance card available when completing your request. Your request will be processed during normal business hours, Monday - Friday, 8:00 am – 5:30 pm, excluding holidays.

  • If we are able to complete your request based on the information provided, your appointment will be scheduled and you will receive an email notification of your appointment date and time.
  • If we are unable to schedule your appointment based on the information provided and need further clarification, a scheduling representative will call you the next business day.
  • For MRI and CT exams, a WRA scheduler will always contact you by telephone to make your appointment. These two exams require more detailed clinical information at the time of scheduling, and we’ll need to speak with you before we can finalize your appointment.

* Indicates Mandatory Fields

I would like to request an appointment for: * Mammogram Screening Other Exam
Please enter the exam your physician ordered:
Name of Insurance Plan:
Your Full Name: *
Address:
City / State / Zip:
Date of Birth: *
(Month/Day/Year)
Email Address: *
Please Provide a 10 digit primary phone number to contact you during daytime hours. Any additional phone numbers that we may use should also be listed.
Phone 1: * Home   Cell   Work
Phone 2: Home   Cell   Work
Phone 3: Home   Cell   Work
May we leave a voicemail message if prompted? * Yes   No
Our schedulers are available to contact you Monday-Friday between the hours of 8:00 am – 5:00 pm, excluding holidays.
Select the best time of the day to reach you:
Specific Time:
Referring Physician's Information
Full Name: *
Office Phone: *
Office Address:
City / State / Zip:
Please indicate the office location you would like for your appointment. We will make every effort to accommodate your request.
*Appointment Location:
Please indicate the day and time preference for your appointment. We will contact you with our first available appointment and make every effort to accommodate your request.
Appointment Day:
Appointment Time:
Comments:
Captcha: