Outpatient CT Referral Request Form
This is for a standard CT scan. If you are also wishing to refer your patient to Internal Medicine department for a myelogram, biopsy or other specialized CT with consult, please fill out the IM referral form as well
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.
