Physicians Referral Form

Our referral forms allow our referring providers to conveniently order radiology services and procedures for their patients. The reverse side contains pertinent information for their study including items to bring for their exam and patient preparations.

West Covina

West Covina
1700 W. West Covina Pkwy.
West Covina, CA 91790 

Upland

Upland
1183 E. Foothill Blvd.
Suite 235
Upland, CA 91786

Ontario

Ontario
3115 E. Guasti Road
Ontario, CA 91761

Covina

Covina
1433 N. Hollenbeck Ave
Suite 105
Covina, CA 91722

Pomona

Pomona
1555 N. Orange Grove Ave
Pomona, CA 91767

Downey

Downey
10226 Lakewood Blvd.
Downey, CA 90241

El Monte

El Monte
11436 Garvey Avenue, Suite D.
El Monte, CA 91732

Chino (Temporary)

Chino (Temporary)
5540 Philadelphia Street, Suite H.
Chino, CA 91710