Book Online - Aim Medical Imaging

Personal Information

Name:*

First Name Last Name

Email:*

Telephone:*

Home Address:

Street Address Address Line 2 City Province Postal Code

Date of Birth:

Personal Health Number (Care Card):

Are you a MyCare member?

Preferred Appointment Date:*

Preferred Appointment Time:*

HH :

MM

Areas to Scan:

Please check the areas to scan

Other Areas to Scan:

Upload copy of requisition:

Max. file size: 50 MB.

You can also send your physician referral via:
- Fax: 604-734-2469
- Email [email protected]