About Us Physician Info Patient Info Our Services Directions Educational Links Contact Us Home SCHEDULE PATIENT EXAM Our Scheduling Department will contact you within 24 hours to confirm your appointment. If this exam is urgent, please call us directly at 203-426-3002. Requesting Doctor Name: Dr. Requesting Doctor Email: Patient Name: (first) (last) Patient Daytime Phone: Diagnosis/Symptoms? Exam(s) Requested: Contrast Requested? Yes No   Patient Insurance Carrier: Authorization number (if available) Day desired: Select Monday Tuesday Wednesday Thursday Friday Time desired: Any time Morning Afternoon 7-8am 8-9am 9-10am 10-11am 11am-12pm 12-1pm 1-2pm 2-3pm 3-4:30pm   Protecting your information is a priority. We utilize SSL (Secure Sockets Layer) to ensure safe, secure transactions. With SSL, information sent via the Internet is encrypted, and can be trusted to arrive privately and unaltered. We believe this element provides the most effective way to ensure that your information is protected.