Online Request for Radiology Exam

To request an appointment for a Radiology exam, please provide the following information.  A Radiology scheduling representative will contact you to confirm your appointment by the next business day.  Thank you for choosing Radiology Services at GBMC!



* Indicates required information
Title 
First Name * 
Last Name * 
Date of Birth * 
CONTACT INFORMATION 
Phone number where you can be reached during the day. * 
Best time to call during the day. (Between 7:00am and 5:00pm from Monday to Friday.) * 
Cell Phone Number 
Email Address * 
APPOINTMENT INFORMATION 
Do you have a signed request from your physician? * 

Exam Requested (listed on physician order) 
Reason for Exam (listed on physician order) 
First and Last Name of Referring physician * 
Type of Insurance * 
PREFERRED APPOINTMENT DATE (2-3 choices) 
Date One *  Calendar (mm/dd/yyyy)
Date Two  Calendar (mm/dd/yyyy)
Date Three  Calendar (mm/dd/yyyy)
 

Please bring your insurance card, photo id, and physician order at time of your appointment.  If you have not heard from us by the next business day, call 443-849-2935 for immediate assistance.

Greater Baltimore Medical Center | 6701 North Charles Street | Baltimore, MD 21204 | (443) 849-2000 | TTY (800) 735-2258
© 2014  GBMC. This website is for informational purposes only and not intended as medical advice or a substitute for a consultation with a professional healthcare provider.