Grosse Pointe Physicians X-ray Center will gladly contact you on our next business day to schedule your exam
Please complete the following information:
Who should we contact to schedule this exam?
First Name
*
Last Name
*
Daytime Phone
*
Phone 2
Best Time to reach
you betwen 8 and 5
Type of Exam needed
*
Please be sure to include all procedures listed on the prescription you received from your doctor.
Day(s) Prefered
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time Prefered
Morning
Afternoon
Prefered Date
mm/dd
Patient's Information
Patient's Name
Patient's Date of Birth
mm/dd/yyyy
Request Appointment
* required information
