Radiant Access

Request an Appointment

Have your practitioner's requisition ready — the form takes about five minutes.

Step 1

Patient information

First name *

Last name *

Date of birth *

Phone *

Email *

Street address *

City *

Province *

Postal code *

Step 2

Referral & documents

A requisition from a licensed practitioner is required for your scan, but you do not need it to send this form. If you cannot upload it now, bring it with you to your appointment.

Referring practitioner *

Clinic or practice name *

Practitioner phone (optional)

Requisition *

Step 3

MRI safety questionnaire

These questions keep you safe in the scanner, and a technologist reviews every answer. Please answer what you can — if you are not sure about something, say so, and skip anything you cannot answer. We would rather call you than have you guess.

Step 4

Consent

Each consent below is separate. The first two are required to process your request.

Collection of personal health information *I consent to Radiant Medical Systems collecting the information in this form, my requisition, and my identification to process my request for an appointment.Use for booking and scan delivery *I consent to this information being used to review my requisition, contact me about appointment times, and deliver my scan.Text message (SMS) communication (optional)I consent to receiving appointment-related text messages. Messages never include medical details. Email is used if this is not selected.

Your requisition contains the clinical information — please do not describe your symptoms or condition anywhere in this form. Every request is reviewed before booking. We will contact you within 2–3 business days.