Ordering Diagnostic Imaging

To arrange an appointment, please contact the access team via the number below.

UAB Medicine Imaging Appointments: 205.801.8750

Patients Legal Name*

First Last

Preferred name (if different from Legal name)

Prefix First Last

Select a preference

Patient Date of Birth*

Patient Phone Number*

Patient Email*

Reason for Exam*

Signs and Symptoms*

ICD-10 Code*

CPT Code*

Insurance Information (Group/Claim#)*

Pre Cert/Auth#*

Effective Date

Expiration Date*

Diagnostic Imaging*

Radiology (Xray)
Fluoroscope (GI)
Mammography
CT
Ultrasound
Angiography
Bone Density (DEXA) (*For a Nuclear Medicine bone scan please call 975-8326)
MRI
Other

PLEASE SELECT A DIAGNOSTIC IMAGING LOCATION

UAB Medicine Leeds

Select this location

Gardendale Primary & Specialty Care

Select this location

The Kirklin Clinic of UAB Hospital

Select this location

UAB Medicine Leeds
1141 Payton Way
Leeds, AL 35094
Hours: 8 am-5 pm
Monday through Friday

X-ray
Mammogram
Ultrasound
MRI
CT scans

Gardendale Primary & Specialty Care
960 Rocket Way
Gardendale, AL 35071
Hours: 8 am-5 pm
Monday through Friday

X-ray
Mammogram
Ultrasound
MRI
CT scans

The Kirklin Clinic of UAB Hospital
2000 6th Ave. South
Birmingham, AL 35233
Hours: 7 am-7 pm
Monday through Friday

MRI
CT scans
Ultrasound
Diagnostic radiology
Gastrointestinal (GI) radiology
Screening and diagnostic mammograms & procedures

Hoover Primary & Specialty Care

Select this location

UAB Hospital-Highlands

Select this location

First Available. No Prefererence

Select this option

Hoover Primary & Specialty Care
501 Emery Drive West
Hoover, AL 35244
Hours: 8 am-5 pm
Monday through Friday

X-ray
Mammogram
Ultrasound

UAB Hospital-Highlands
1201 11th Ave. South
Birmingham, AL 35205
Hours: 7 am-5 pm
Monday through Friday

MRI
CT Scans
Ultrasound
Diagnostic Radiology

If you do not have a location preference or want first available, select this option

Other*

Area(s) to be Imaged*

Biopsy or Aspiration*

Iodinated Contrast*

Without
With
With and Without

Gadolinium Contrast*

Without
With
With and Without
Discretion of Radiologist

Creatine (value, date, if available)*

Allergies*

Physician Name/NPI #*

Clinic Contact*

Phone Number*

Fax Number*

* I understand that by hitting submit this will serve as an electronic signature that has the same legal effect and can be enforced in the same way as a written signature.