Request Images Form

Your request for images will be processed within two days 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, x222. If you are picking up your images, you will be asked for identification and a signature at the time of pickup.

Please note

For most exams, an automatic-loading CD with your exam images will be provided unless there is a pre-existing arrangement with your doctor.

Patient Information
  1. (required)
  2. (required)
  3. (required)
  4. (valid email required)
Images Requested
  1. (required)
  2. (required)
  3. (required)
Pickup or Mail Images
  1. I will pick up my images at the following location:
  2. * Only fill in the fields below if an address is
       not selected above.
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