Request an imaging appointment

To request an appointment, you need a completed imaging request form from a clinician (GP, consultant, allied healthcare professional).

Alternatively, you can book with one of our expert consultants who will be able to request the imaging required.

We can usually see these requests on the same day. Please complete this form to request an appointment

Radiology appointment patient request

Note: Questions marked by * are mandatory

*This is a mandatory field. Scan type

Please Select An Option MRICardiac MRIUltrasoundX-rayCTCardiac CTMammogramEchocardiogram

*This is a mandatory field. Body part requested

Please Select An Option Lumbar spineBrain/headIAMs - inner earOrbits - eyesKnee - rightKnee - leftCervical spineNeckHeartThoracic spineShoulder - rightShoulder - leftHip - rightHip - leftMRCP – pancreas, gallbladder and bile ductsFemale pelvis - gynaecologicalPelvisAnkle - rightAnkle - leftLiverRenal scanFoot - rightFoot - leftProstate MPMSacroiliac jointsCoccyxWrist - rightWrist - leftThigh - rightThigh - leftElbow - rightElbow - leftHand - rightHand - leftThyroidCoronary angiogramPituitary fossaSmall bowelUrinary tractAdrenalsBreast - rightBreast - leftSinusesFemur - rightFemur - leftPancreas

*This is a mandatory field. Appointment time request

Please Select An Option As soon as possibleMonday - Friday: morningsMonday - Friday: afternoonsMonday - Friday: eveningsWeekend appointmentOther; our team will discuss availability with you.

*This is a mandatory field. Do you have a referral

Please Select An Option YesNo

*This is a mandatory field. How are you funding your scan?

Please Select An Option Pay for myself/self-fundingMedical insuranceNHS

*This is a mandatory field. Full name

*This is a mandatory field. Date of birth

*This is a mandatory field. Email

*This is a mandatory field. Contact number

*This is a mandatory field. Contact preference

Please Select An Option EmailTelephonePost

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