Online Appointment Form - Rolling Oaks Radiology - (805) 778-1513 - Serving Ventura County, Thousand Oaks & Surrounding Areas

Rolling Oaks Radiology Online Scheduling

A Rolling Oaks Radiology professional scheduler will contact you the next business day to schedule an appointment. If you would prefer to call us, please dial (805)778-1513, and we will be glad to assist you. Please fill out the information below and a scheduler will contact you shortly.

Do you have a written requisition from your doctor for the imaging procedure you would like to schedule?: *

yes

Please note: We can not perform a diagnostic imaging procedure without a written requisition from your referring physician. Please contact your referring physician's office to obtain the proper requisition.

Patient Information

First Name: *

Last Name: *

Date of Birth: *

Home Phone: *

Alternate Phone:

Contact Email: *

I prefer to be contacted by: *

Imaging Procedure

Referring Physician:

Type of Procedure:

** Scheduling department hours are Monday through Friday, from 7 a.m. to 6 p.m