Have Your X-Ray Films
Sent to You

To have your x-rays sent to you from our storage facility, please fill in the fields below. Please allow 5-10 business days to receive the x-rays from the date that you've filled out this form.

When you click enter below, you will be asked to pay a one-time $18 fee through any credit card.

First Name:

Last Name:

Address:

City:

State:

Zip:

Date of Birth:

Phone Number:

E-mail Address:

I agree that I am the patient who is requesting these films.

NOTE: If you are a representative of the patient (such as a law firm or other office), you will need the patient to come to this web site directly to fill out this information. At this time, we are unable to process requests from parties other than the patient.

I agree that once I pick up these x-ray films, I will not return them to Susan Gootnick Radiology or to their storage facility.

Have Your X-Ray FilmsSent to You

Have Your X-Ray Films
Sent to You