Request an Appointment - North Carolina Diagnostic Imaging

Our online "Request an Appointment" feature is for patients who have a signed physician's order and would like to schedule a future appointment. This feature is not intended for same-day appointments.

To request an appointment at North Carolina Diagnostic Imaging, please complete the form below and click "Submit." A scheduling representative will contact you to collect additional information and schedule your appointment.

For faster assistance, please call us at (833) 438-2674.

Do You Have A Physician's Order?

We accept all physician-signed orders, even if they are on a hospital order form or prescription pad.

If yes, please proceed. If not, please contact your referring physician to obtain an order.

Do you have a signed physician's order?

Do you have a signed physician's order? Yes No

Your Information

Your Name *

Insurance Carrier *

The Best Way To Reach You

Preferred method of contact *

Preferred method of contact Email Phone

Your email address *

Confirm Email Address *

Primary phone number Primary phone number * - ### - ### ####

Alternate phone number Alternate phone number - ### - ### ####

Appointment Details - North Carolina Diagnostic Imaging

What day and time would you like your appointment? We will do our best to find a time that works for you, but cannot guarantee the time you have requested.

Location *

Date you would like to be seen Date you would like to be seen * / MM / DD YYYY

Time you would like to be seen *

Time you would like to be seen Anytime Morning Afternoon

Additional Information

How did you hear about us? *

If other, please let us know how.

PLEASE NOTE:

If you elected to be contacted by email, please note that all correspondence from North Carolina Diagnostic Imaging will be encrypted, and you will need to log into a secure portal to retrieve your messages. *

If you elected to be contacted by email, please note that all correspondence from North Carolina Diagnostic Imaging will be encrypted, and you will need to log into a secure portal to retrieve your messages. I agree

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