Requisition Form

Doctors please use the General Requisition Form link below. OBS/GYNs, Obstetricians and Gynecologists use the Obs Gyn Requisition Form link in the second box. 

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General Requisition Form

Click below to download your requisition form.

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Obs Gyn Requisition Form

Click below to download your requisition form.

View Pdf

New Patients Always Welcome, Ottawa

Make Us Part of Your Healthcare Team

We'll collaborate with your healthcare team to create a streamlined imaging and diagnostics process. Find out how we can help.

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(613) 686-1904