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Rochester General Imaging

Phone: (585) 922-XRAY (9729)

Request Requisitions

Rochester General Imaging offers a superior level of diagnostic, interventional and therapeutic services.

We request written requisitions to perform exams. Use the form below to request general diagnostic, MRI or PET/CT scan requisition forms.

Your request will be processed within 24 hours during regular business hours, Monday-Friday 8:00 am- 5:00 pm. If you do not hear from us by phone or email to confirm your request, please call us at (585) 922-XRAY (9729).

* = Required field



* Provider Name:

* Practice Name:
Address and Suite:
Zip / Postal Code:
* Phone:
* Email:
(valid email required)

* Requisition Form Needed:
(CT Scan, MRI, X-ray)

* Quantity:


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