Request an Appointment

To request an appointment, please call our Central Scheduling department at (716) 649-9000 or complete the following form and a representative will contact you. X-rays must be scheduled in advance.

Name*
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email*
Referring Doctor
Insurance Provider
Test / Procedure
Preferred Location
Best time to contact you
Phone
This field is for validation purposes and should be left unchanged.