Send Referral - Santa Fe Imaging

(505) 983-9350

Got Your Order? Email it to IT_SUPPORT@santafeimaging.com

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Phone Number *

Please enter number where you can be reached at. No hyphens.

Has Your Provider Ordered Your Exam *

PLEASE NOTE THAT IF YOUR PROVIDER HAS NOT FAXED, EMAILED, OR ELECTRONICALLY ORDERED YOUR EXAM, THEN WE CANNOT SCHEDULE YOUR APPOINTMENT

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Please upload physician referral if you have it

For Appointments 505-983-9350

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SAVE TIME! Please complete the form and we will call you to schedule an appointment. WE ARE EXPERIENCING HIGH INBOUND CALLS. AVOID THE WAIT! Please note that XRAYS are done on a walk-in basis. All we need is orders from your provider. NO appointment needed.

Name *

Date of Birth *//

Email *

Phone *

No hyphens

Type of Exam *

Mammography
MRI
XRAY
CT
Ultrasound
Other

Please check all that apply. Please note all XRAY exams are walk-ins. If scheduling for mammogram, ask about same or next day appointments.

Please Specify Exam Needed *

Has Your Provider Ordered Your Exam *

PLEASE NOTE THAT IF YOUR PROVIDER HAS NOT FAXED, EMAILED, OR ELECTRONICALLY ORDERED YOUR EXAM, THEN WE CANNOT SCHEDULE YOUR APPOINTMENT

Who Ordered Your Exam *

Please enter name of provider who ordered your exam

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**NOTE: IF YOU HAVE EVER HAD PRIOR IMAGING DONE FOR THE CURRENT BODY PART, WE WILL NEED THOSE IMAGES FOR COMPARISON. WITHOUT THOSE IMAGES, THERE COULD BE A DELAY IN REPORTING YOUR EXAM.

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