To assist physicians and their staff in referring patients to Jefferson Radiology, we have made available a copy of the Patient Requisition form for your use.

For routine studies, your office can call our central schedulers (860) 289-3375. The earliest and most convenient appointment will be set up for your patient. We must receive a written request containing the clinical information and diagnosis. This should be faxed to our schedulers at 860-290-4108 and then given to your patient to bring to their appointment. A printable copy of our request form can be downloaded here.