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Oshawa Ultrasound
Diagnostic Services
info@oshawaimaging.ca
(905) 576-2622
Requisition Form
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Requisition Form
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Humberger Toggle Menu
Home
Our Procedures
Patients
Requisition Form
Book Appointment
Patient Survey
Our Team
Contact
FAQ
Humberger Toggle Menu
Request Appointment
Book Your Appointment
Book Your Appointment in 3 Simple Steps
Step 1.
Complete the form below.
Step 2.
Please ensure the physician selected all the appropriate tests on your requisition.
Step 3.
Submit the form and wait until our staff will contact you with a prompt confirmation.
Patient Booking
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Name
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First
Last
Email
*
Phone Number
*
Upload a photo or a scan of your Requisition/ Referral ( PDF, JPEG,PNG)
Click or drag a file to this area to upload.
Submit
