Request an Appointment « Welcome to Rochester Radiology

Request an Appointment

Please use this form to request a non-urgent appointment only. Your request will be processed within 24 hours during regular business hours, Monday–Friday, 8 a.m.–5 p.m. If you do not hear from us by phone or e-mail to confirm your request or if you have questions about your appointment, please call us at 585.336.5000, Option 2.

Please Note: We cannot perform an imaging exam without a written requisition from your physician. Please contact your physician’s office to obtain the proper requisition.

Appointments are not necessary for plain x-rays such as chest, leg or arm x-rays. These exams are available on a walk-in basis Monday–Friday, 8 a.m.–4:30 p.m. with a written request by your physician.

Patient Information

First Name(required)
Last Name(required)
Date of Birth (mm/dd/yyyy)(required)
Address
City
State
Zip/Postal Code
Phone(required)
Alternate Phone
E-Mail Address(valid email required)
Please Contact Me By (Check all that Apply)
phone alternate phone e-mail
Referring Physician Name
Request Completed By

Appointment Information

Exam Requested
Mammogram DEXA Scan Ultrasound CT Scan Other
If other, please specify
Reason for Exam
Preferred Date (mm/dd/yyyy)(required)
Preferred Time(required)
Special Instructions

Terms of Use By agreeing to the terms of use for online forms, you will enter a secure area of our site. Rochester Radiology and RDI will be held harmless should your electronic message not be transmitted due to technical problems. Rochester Radiology and RDI are HIPAA-compliant. Individually identifiable information is encrypted and your message will not be forwarded to other parties outside of our organization. The information will be used only by Rochester Radiology and RDI. Your request will be processed within 24 hours during regular business hours, Monday–Friday, 8 a.m.–5 p.m. If you do not hear from us by phone or e-mail to confirm your request, please call us at 585.336.5000. Please note You must accept the terms of use in order to process your request(s) online.
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Please Note

You must accept the terms of use in order to process your request(s) online.

Terms of Use

By agreeing to the terms of use for online forms, you will enter a secure area of our site. Rochester Radiology and RDI will be held harmless should your electronic message not be transmitted due to technical problems. Rochester Radiology and RDI are HIPAA-compliant. Individually identifiable information is encrypted and your message will not be forwarded to other parties outside of our organization. The information will be used only by Rochester Radiology and RDI.

"As Chief of Neurosurgery at Rochester General, I find RDI a great asset to my practice. They are professional, flexible, and kind to patients. The RDI radiologists’ interpretation of films is very thorough and accurate."

- Dr. Maxwell