Mount Carmel Health System

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Imaging Appointment Request

Mount Carmel makes requesting an imaging appointment easy. If you have a physician order, simply fill out our request form. You'll be asked for some personal information, the test type, your preferred appointment date and the best time to reach you. We will review your request and physician's order and follow up with you shortly to schedule your appointment. If you do not have a physician order or your physician is faxing the order, please call 614-234-7400. For mammography, please call 614-234-2900.

Please note: You do not need a physician order to schedule a screening mammogram. And while you do need a physician order for an X-ray, you do not need a scheduled appointment.

First Name 

Last Name 

Test Type 


Date Of Birth * 

Email Address * 

Phone Number * 

Preferred Date * 

Time To Call * 

* Indicates required information   

©  2014  

Mount Carmel Health System  |  Columbus, Ohio

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