Radiology Imaging Request

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.