Regional Medical Imaging
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Request an Appointment

By agreeing to the terms of our secure forms, you will enter a secure area of our web site. RMI will not be held responsible in the event your electronic message is not transmitted due to technical problems related to this site or to the hosting server. All personal identifying information is encrypted and your message will not be internally or externally forwarded to other parties. The information will solely be used by RMI.

Your request will be processed within 48 hours, during normal business hours, Monday - Friday, 9:00 am - 4:30 pm, excluding holidays. If you do not hear from us within that timeframe, please contact us by phone at (810) 732-1919.

If you do not accept the terms of this disclaimer, you will not be able to process your request on-line.
If you have any questions regarding the use of these forms, please contact our office during normal business hours at (810) 732-1919.

Request an Appointment Form
Use this form for non-urgent appointments only.
For urgent appointments within 24 hours, please contact us by phone at (810) 732-1919. An asterisk (*) indicates required information.

PATIENT INFORMATION  
First Name*
Last Name*
Email*
Date of Birth*
Primary Phone*
Alternate Phone
APPOINTMENT INFORMATION  
Patient Status*
Preferred Day For Appointment*
Preferred Time For Appointment*
Preferred Location*
Best Phone Number to Use*
Best Time to Call*
Type of Exam*
Name of Physician Ordering Exam*
General Comments/Questions
 
 

 
Regional Medical Imaging, P.C. | 3346 Lennon Road, Flint, Michigan, 48507 | (810) 732-1919
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