- All ultrasound exams must be requested using the Ultrasound Request Form.
- The form must be received by our Radiology Department before an appointment will be scheduled.
You will need either Adobe Acrobat or Adobe Reader to view these forms. To download a free version of Adobe Reader, please click here.
For users with Adobe Acrobat:
- Click on the desired form above and it will open with Adobe Acrobat.
- After completion of the form on your computer, please print the form and fax to 540-231-9238.
For users with Adobe Reader:
- Click on the desired form above and it will open with Adobe Reader.
- After completion of the form on your computer, you may print the form and fax to 540-231-9238.
- You will not be able to save the completed form on your computer using Adobe Reader. Please print a second copy for your records.