Appointment Request Form

If you are experiencing a medical emergency, call 911 or your local emergency access provider.

Please allow 24 hours for your request to be processed. After-hours submissions will be processed the next business day.

For same day or urgent radiology requests please call (334) 528-1156.

If you are unable to upload an electronic copy of supporting documentation, please fax it to (334) 528-3262.

Scheduling Department

Monday - Thursday 7:00AM - 5:30PM CST
Friday 7:00AM - 5:00PM CST

Fax
(334) 528-3262
Your Information
  Send Text/SMS confirmation.
Format: mm/dd/yyyy
XXX-XX-
Last 4 digits only
  Send Text/SMS confirmation.
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Appointment
For same day or urgent radiology requests please call  (334) 528-1156
Type of Exam(s)
Type LAST FIRST to search physicians. 3 letter minimum.
Preferred Day
Preferred Time
Comments / Questions
Order/Prescription Upload

Scheduling Department

Monday - Thursday 7:00AM - 5:30PM CST
Friday 7:00AM - 5:00PM CST

Fax
(334) 528-3262
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