Request an Appointment - Cypress Imaging

Our Complete Schedule of Imaging Services Now Available

We are pleased to have resumed a complete schedule of imaging services beginning May 4th. Read more about what we’re doing.

Request a Non-Urgent Appointment

Fill out the form below and a member of our staff will call you within one business day. Please have the order from your physician and your insurance card available for reference when we contact you. Information submitted on this form may not be secure or confidential.

Or Call 316-858-5200 to Schedule an Appointment

Please note that your appointment is not scheduled until you receive a phone or email confirmation from a member of our staff.

Fill Out This Form to Request an Appointment

Do I Qualify for a Screening Mammogram?

You DO NOT qualify for a screening mammogram if you've had breast cancer or if you are experiencing any of the following:
- Unilateral new pain
- New discharge
- Lump(s), mass, density
- New nipple inversion
- Short-term follow-up or any follow-up suggested by radiologist
Are you qualified for a Screening Mammogram?*
- I qualify for a screening mammogram.
Do you have an order from your physician for this exam?*
- Yes
- No
Please note: We can not perform your imaging exam without a written order from your referring physician – unless you are requesting an appointment for a screening mammogram. For all other exams, if you do not have an order, please contact your referring physician's office to obtain an order and then return to this site to request your appointment.
First Name*
Last Name*
Date of Birth*
Contact Phone*
Alternate Phone
Email
How do you prefer we contact you?*
May we leave a voicemail?*
- Yes
- No
Referring Physician's Name*
Type of exam requested
Which location do you prefer?
Please list two days and times that you prefer to have your appointment scheduled. Please note, we may not be able to accommodate all requests.
Day/Time 1
Day/Time 2
Name
This field is for validation purposes and should be left unchanged.

Our Complete Schedule of Imaging Services Now Available

Request a Non-Urgent Appointment

Or Call 316-858-5200 to Schedule an Appointment

Fill Out This Form to Request an Appointment

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Cypress Imaging Locations