PET Emergency Treatment
Outpatient CT Referral Request Form
This is for a standard CT scan.
If you are referring a patient for a CT scan along with an Internal Medicine (IM) consult, please ensure that all relevant information is included in the IM referral form instead of the CT referral form.
If you are referring a patient for a CT scan at PET Emergency Treatment Inc., please fill out the form below. We'll need confirmation that all lab work has been performed prior to the scan & please note that we are not responsible for interpreting or relaying results to the owner.
