Online Scheduling Request
You may request an exam online by completing the following information. A scheduler will call you within 24 hours to confirm your appointment.
* Required Fields

  Are you a returning patient? YES   NO
  Is this appointment urgent? YES   NO
* First Name:  
* Last Name:  
* Date of Birth (month/date/year):
  Work Phone Number:  
* Home Phone Number:  
  Best Time to Call:  
  First Name of Physician Ordering Exam: 
  Last Name of Physician:
  Phone Number of Physician:  
*
Name of Exam:  
  Specify Body Area:
* Please briefly describe the symptoms that prompted this test:  
  Please add any other contact information:  
 
Have you obtained written authorization from your physician?  
  YES   NO  
  Please select the location most convenient for you:
 
EPIC IMAGING|EAST
233 NE 102ND AVE.
PORTLAND		 EPIC IMAGING|WEST
8950 SW NIMBUS AVE.
BEAVERTON
  Note: If you are having a PET Scan or nuclear medicine procedure, you will be scheduled at the Portland PET Center located at 143 NE 102nd Ave., Portland, OR. Our scheduler will let you know if this applies to you when you are called.
 
Has your physician already scheduled your return appointment?
  YES  NO  UNKNOWN
  If yes, date of appointment:  
  Time of appointment:  
  Please select 3 days of the week that would be convenient for you.
  1st choice:  
  2nd choice:  
  3rd choice:  
  Would you prefer morning or afternoon?
AM  PM
  While we will do our best to accommodate your request, it is not always possible. Please be assured you will receive the first available appointment.