Willamette Valley Imaging, your medical imaging experts
About Willamette Valley Imaging
About WVI's Facility
WVI Patient Information
Referring Physician Information
WVI Billing and Insurance Information
Contact Board-Certified Radiologists at WVI
News and Media from WVI
Map & Directions to WVI

Scheduling Phone Numbers

Main Number: 541-344-9500

Fax Number: 541-344-9510

Order by Fax

To place an order by Fax, please download our Order Request Form. Please fax PATIENT DEMOGRAPHICS and/or ORDER to:

FAX Number: 541-344-9510

View Results

Imaging results from exams may be viewed via Imagecast or Carecast.

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WVI Online Scheduling Request

Required Fields are labeld in RED TYPE.

Please fill out the form below to schedule a patient appointment with WVI:

General Information

Referring Offices:
Stat, Call Report or Stat Call Report?  Stat     Call Report  Stat Call Report 
Order Requested by:  Nurse     PA  MD 
Order completed by:
Ref. Physician: Physician's Ph. #:
Addit. Reports To: Next Follow-up
Dr. Appointment:
MM/DD/YYYY
Insurance Provider: Policy #:
Requested Appointment Date/Time:
MM/DD/YYYY
Group #:
Pre-Auth Needed?  Yes     No     Secondary Insurance?  Yes     No    

Patient Information

Patient Name: Patient DOB: MM/DD/YYYY
Phone #: Other Phone #:
Street Address: City:
State:
Zip:

General Exam Information (all exams)

Exam(s) Requested:
CTMRI
CT Post DiscogramCT Post Myelogram
MRACTA
IV Contrast?  Yes     No     At Radiologist's Discretion 

Examination/Area(s) of Special Interest:
ICD-10 / Signs & Symptoms / Clinical Indications:
Comments:
Previous Exams:
MRIOther
CT
Previous Related Surgery:  Yes     No 
Pregnant?:  Yes     No 
Patient's Height:
(please specify in. or cm.)
Patient's Weight:
(please specify lbs. or kg.)

Please fill out all of the required fields marked in red.

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