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General Diagnostic Imaging Requisition BOOKING Phone: 587.885.2988 | Fax: 587.885.2989 | Email: Booking@beamradiology.com | www.beamradiology.com DATE OF REQUEST (D/M/Y):APT. DATE (D/M/Y):TIME:PATIENT

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X-ray services - eagle refer to the specific type of X-ray services provided by Eagle Medical Center.

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On x-ray services - eagle, information such as patient details, date of service, type of X-ray service provided, and any additional notes must be reported.

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