X-ray order form

Send the request below and our scheduling team picks it up straight away, in-clinic or mobile to the patient.

A provider's order is required. The form below reaches our scheduling team and a person confirms the details with you. It is not where the signed order goes: send that through the RapidRAD portal, or download the X-ray order form (PDF) and fax it to (406) 206-5015. Please keep patient identifiers out of the form below.

X-ray

Request an X-ray.

Tell us what you need and our scheduling team confirms the details with you, usually the same day. Fields marked * are required.

Ordering provider name *

Facility / practice

Phone *

Email *

Patient city / region

Modality needed

In-clinic or mobile

Urgency

Payment

Body part and views

Notes

A team member will confirm the details with you before anything is scheduled. Please do not include full patient identifiers you would not send by email. For urgent needs, call (855) 249-9729.

Other ways to order: the RapidRAD portal, the printable order form by fax to (406) 206-5015, or by phone. See all four options.