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Rochester General Imaging

Phone: (585) 922-XRAY (9729)

Request An Imaging Appointment

Please use this form to request a non-urgent appointment only. Your request will be processed within 24 hours during regular business hours, Monday-Friday: 8:00 am - 6:00 pm. If you do not hear from us by phone or email to confirm your request or if you have questions about your appointment, please call us at (585) 922-XRAY (9729).

*** PLEASE NOTE: We cannot perform an imaging exam without a written requisition from your physician. Please contact your physician's office to obtain the proper requisition.

Appointments are not necessary for plain x-rays such as chest, leg or arm x-rays. These exams are available on a walk-in basis Monday-Friday: 8:00 am - 4:30 pm with a written request by your physician.

* = Required field



* First Name:

* Last Name:
* Date of Birth:
Mailing Address:
Zip / Postal Code:
* Phone:

Alternate Phone:

* Email:
(valid email required)

* Please contact me by (check all that apply):

* Referring Physician Name:
Insurance Provider:
Policy Number:


Exam Requested:

: If other, please specify:

Reason for Exam:

* Preferred Date:
* Preferred Time:
Preferred Location:
Special Instructions:


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