Film Request Form
By agreeing to the terms of our secure forms, you will enter a secure area of our web site. Diagnostic Imaging of Southbury 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 Diagnostic Imaging of Southbury. If you do not accept the terms of this disclaimer, you will not be able to process your request on-line.
We will confirm your request by phone or by email. On-line requests will be followed up within one business day of request receipt, Monday through Friday, 8:00 a.m. and 5:00 p.m. If you do not receive a response from us within 48 hours, or if you have any questions, please contact our office by phone at (203) 267-5800.
Important Items to Note
- Allow 2-3 days advance notice of desired film pick up.
- When picking up your films or reports, you will need to present photo identification. If someone other than the patient is picking up the films, a signed, written authorization from the patient is required.
- Mammogram films are loaned to you and should be returned as soon as possible.
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