1618 Washington Blvd, Fremont, CA 94539
510-657-6343
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CT Scan Referral

  • Patient Information

  • Please specify weight in Kg/Lb.
  • Referral Information

  • Note: Consultation appointments will be set up with the specialist prior to the scan being performed. The CT fee does not include the specialists office visit fee.
  • Note: This information will be needed for the radiology review.
  • Note: Contrast fee will be dependent on the patient’s weight.
  • MM slash DD slash YYYY
  • Max. file size: 15 MB.
1618 Washington Blvd, Fremont, CA 94539
510-657-6343
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