PATIENT PORTAL APPOINTMENTS PAY MY BILL CONTACT US 317-972-9669 PROCEDURES SUBSPECIALTIES LOCATIONS PATIENT RESOURCES FOR PROVIDERS PRICING ABOUT STRATEGIC RADIOLOGY Northwest Radiology Network is a founding member of Strategic Radiology, an organization comprised of large radiology practices geographically dispersed throughout the US. The Strategic Radiology group represents more than 1,300 radiologists and supports the mission of “improving lives by creating superior radiology value through collaboration.” The practices are uniquely suited to a collaborative model in which data and best practices are shared, clinical practice information is interchanged, and certain practice expenses are consolidated. Through the sharing of best practices with like-minded physicians and experienced radiology business professionals, Strategic Radiology has the capability to deploy innovative processes and technologies across member group practices, enabling higher quality and operational efficiency. Strategic Radiology provides quality patient care utilizing collaborative best practices. 317-972-9669 | 800-400-9729 | Fax: 317-715-9990 Contact Us | Terms of Use | Privacy Information STAY CONNECTED © 2021 Northwest Radiology Network, PC (Notice of Non-Discrimination)

PATIENT PORTAL APPOINTMENTS PAY MY BILL CONTACT US 317-972-9669 PROCEDURES SUBSPECIALTIES LOCATIONS PATIENT RESOURCES FOR PROVIDERS PRICING ABOUT REQUEST AN APPOINTMENT PLEASE COMPLETE THE FORM BELOW AND A SCHEDULER WILL CONTACT YOU WITHIN 1-2 BUSINESS DAYS TO CONFIRM YOUR APPOINTMENT. A DOCTOR'S ORDER MUST BE FAXED TO US IN ORDER TO SCHEDULE ANY APPOINTMENT OTHER THAN A SCREENING MAMMOGRAM OR X-RAY. IF YOU WOULD LIKE IMMEDIATE ASSISTANCE, PLEASE CALL 317-972-9669 OR 800-400-9729 OPTION 2, MON. – FRI. 8 AM – 5 PM. WALK-INS ONLY FOR GENERAL X-RAYS. BE SURE TO BRING YOUR DOCTOR’S ORDER TO ONE OF OUR IMAGING CENTERS DURING THE HOURS OF OPERATION. CLICK HERE FOR LOCATIONS AND HOURS. PLEASE CLICK HERE TO SCHEDULE A SCREENING MAMMOGRAM. FOR ALL OTHER EXAMS PLEASE SUBMIT THE FORM BELOW. *Appointment Requested by: Patient Physician *First Name: *Last Name: *Date of Birth: *Email Address: *Primary Phone: *Alternate Phone: *Preferred Contact Method: Phone Email *Type of Exam(s) Needed (check all that apply): CT DEXA Bone Density MRI Mammogram Nuclear Medicine PET/CT UltraSound *Preferred Location: No Preference *Preferred Date: *Alternate Date: *Preferred Time: Early Morning Mid Morning Afternoon Evening Any Time *Symptoms / Reason for Exam: *Health Insurance Provider: *Policy Number: Upload a photo or scan of your insurance card. (optional) *Front of Card: *Back of Card: *Do you have a doctor's order? Yes No Doctor's order is required for all appointments except screening mammograms. *Referring Provider's Name: SUBMIT If you need to cancel your appointment, we would greatly appreciate if you would provide 24 hours notice. 317-972-9669 | 800-400-9729 | Fax: 317-715-9990 Contact Us | Terms of Use | Privacy Information STAY CONNECTED © 2021 Northwest Radiology Network, PC (Notice of Non-Discrimination)