Request an Imaging Appointment

Wake Forest Baptist Imaging is pleased to be able to offer online requests for imaging exams. Please fill in the fields below to the best of your ability.
*With the exception of mammography, all exams will require a referral from your physician prior to scheduling

Physician Name:
*First Name:
Middle Initial:
*Last Name:
*Birthdate: [MM/DD/YYYY]
*Email:
*Home Phone:
Work Phone:
Street Address:
City:
State:
Zip:
Preferred Appointment Date:
Exam Type:
Preferred Time of Day:
How Did You Hear About Us?:

MyAtriumHealth

Request an Imaging Appointment