Non-Urgent Appointment Request Form

If you are visiting any clinic office and want to save time in filling the forms at home, please visit Patient forms section.
When finished downloading forms, print the forms, fill it out, and bring to the clinic for faster processing. 

Patient Information

Please fill the form below. This online request an appointment form may be used to notify OutPatient Imaging that you would like to schedule a "non urgent" appointment. If you require immediate assistance, please call the office closest to your location.

Please note that information submitted on this online request an appointment form may not be secure or confidential. Detailed information regarding your exam and appointment with OPI will be discussed on the phone at the time of scheduling.

Your request will be processed during normal business hours, Monday - Friday, 8:00 am – 5:00 pm, excluding weekends and holidays.

An OPI scheduling representative will attempt to contact you during the next business day. To ensure the accuracy and completeness of your request, please have the order from your physician and your insurance card available for reference..

* Indicates Mandatory Fields


Your current address
eg. Atlanta
eg. Georgia
eg.30303
Please Provide a 10 digit primary phone number to contact you during daytime hours. Any additional phone numbers that we may use should also should be listed.
Our schedulers are available to contact you Monday-Friday between the hours of 8:00 am – 5:00 pm, excluding weekends and holidays.

Referring Physician's Information

eg. Atlanta
eg. Georgia
eg. 30303
Please indicate the office location you would like for your appointment. We will make every effort to accommodate your request. If you are unsure please call 770-305-4674.
Please indicate the day and time preference for your appointment. We will contact you with our first available appointment and make every effort to accommodate your request. This is NOT a guarantee you will get your specified day and time.

How can we help?

Feel free to ask a question or simply leave a comment.


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