Imaging Request Form

For all requests to receive imaging please fill out all required information below and your request will be processed by a member of our team.

 

For questions please call or email

  • Phone (206) 606-1114
  • Email release@seattlecca.org 

Imaging Request

Is this request
Contact
Address
Patient
Records
Exam description Exam date Modality Series in exam / image count
Modality