Referral Forms We have provided patient referral forms in PDF format so they can be printed out, completed and then either given to the patient to bring with on the day of the appointment or faxed to our office. If you prefer printed patient imaging Rx pads for your practice, they can be ordered online along with other supplies. Go to Request Supplies.

WIS Imaging Referral Form (For referring physician’s use only.)

Breast MRI Referral Form (For referring physician’s use only.)

Coronary Artery Calcium Exam (CACS) Referral Form (For referring physician’s use only.)

Sinus CT Exam Referral Form (For referring physician’s use only.)

PET/CT Scan Request Form (For referring physician’s use only.)

Chiropratic Referral Form (For referring physician’s use only.)


If you are unable to open and read the files listed above, you may need to acquire or update your PDF reader. Click here to download Adobe Acrobat Reader for free.

Schedule an Appointment Pay Bill Online Print Patient Forms Ask a Radiologist Take Our Survey Site Map Follow WIS on Twitter	Clinician Resources PACS Log-In Staff Log-In	Washington Imaging Services, LLC has advanced diagnostic imaging centers in Bellevue and Issaquah, Washington to serve patients on the greater Eastside and from Seattle. Our state-of-the-art PET/CT, MDCT, Breast MRI, MRI, ultrasound and x-ray systems capture detailed images that our board certified subspecialty trained radiologists interpret to optimize clinical decision-making.
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