Request an appointment

Request an appointment at Lake Zurich Open MRI for MRI, CT scans, Ultrasound, or X-rays. Submit your details and physician’s order below, and our team will call you to discuss availability and schedule your visit.

Request an Appointment in Lake Zurich

Complete the form below and attach your physician’s order as a PDF, JPG, or PNG file (maximum 6 MB). Submitting a request does not confirm an appointment; our scheduling team will call you.

If your order file is larger than 6 MB, you do not yet have an order, or you need help, please call 847-726-0674. You can also email info@lakezurichopenmri.com for scheduling assistance.

I am a:
PatientPhysicianPhysician's Office

First Name:

Last Name:

Patient's Gender:

Date of Birth:

Email:

Phone Number:

Address:

City:

State:

Zip Code:

Type of Exam Needed:

Do you have an order?

Attach order form (Max file size: 6 MB; PDF, JPG, JPEG or PNG):

Tell us about your problem (up to 1,800 characters):

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If you need help with this check, call (847) 726-0674.

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