Make An Appointment | Borg and Ide Imaging

Thu, 06/04/2009 - 13:20 — admin

A Borg & Ide Imaging professional scheduler will contact you the next business day** to schedule an appointment. If you would prefer to call us, please dial (525) 241-6400, and we will be glad to assist you. Please fill out the information below and a scheduler will contact you shortly.

Do you have a written requisition from your doctor for the imaging procedure you would like to schedule?: *

yes

Please note: We can not perform a diagnostic imaging procedure without a written requisition from your referring physician. Please contact your referring physician's office to obtain the proper requisition.

Patient Information

First Name: *

Last Name: *

Date of Birth: *

Home Phone: *

Alternate Phone:

Contact Email: *

I prefer to be contacted by: *

Imaging Procedure

Referring Physician:

Type of Procedure:

** Scheduling department hours are Monday through Friday, from 8 a.m. to 5 p.m