Request Requisitions « Welcome to Rochester Radiology

Request Requisitions

Rochester Radiology offers Imaging with Insight—a superior level of diagnostic, interventional, and therapeutic services.

We request written requisitions to perform exams. Use the form below to request general diagnostic, MRI, or PET/CT scan requisition forms.

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.

Request Requisition Forms

Provider Name
Practice Name
Address and Suite
City
State
Phone
Email Address(valid email required)
Requisition Form Needed
General Diagnostic PET Scan MRI
Quantity

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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