Radiology Imaging Request
Radiology Services Imaging Request
Hours of Operation: Monday – Friday 8 a.m. to 5 p.m.
24 hour notice preferred for image request to be processed prior to image pick up.
For additional information regarding Radiology imaging request, please contact (678) 450-7851.
Please click link below to access Radiology Imaging request form:
Radiology Imaging Request and Release Form
After submitting the Radiology Imaging Request/Release form, please print and bring with you to the Northeast Georgia Diagnostic Clinic when picking up images.
On day of pickup:
- Radiology Images can be picked up at the Northeast Georgia Diagnostic Clinic West Entrance in Medical Records/Customer Service. (Doorway to the Right of the Greeters desk)
- Patient/Authorized Designee will be required to show photo identification and sign release of authorization.
- Patient Imaging Release Form with patient signature will be required for Authorized Designee to pick up images.
- If Power of Attorney (POA) will be picking up Images, we will need paperwork giving POA authorization.