Clifiton Imagining Center professional scheduler will contact you the next business day** to schedule an appointment. If you would prefer to call us, please dial (973-777-8100, and we will be glad to assist you. Please fill out the information below and a scheduler will contact you shortly.

Do you have a written requisition from your doctor for the imaging procedure you would like to schedule?: *

yes no

Please note: We can not perform a diagnostic imaging procedure without a written requisition from your referring physician. Please contact your referring physician's office to obtain the proper requisition.

Patient Information
First Name:
Last Name:
Date of Birth:
Home Phone:
Alternate Phone:
Contact Email:
Imaging Procedure
Referring Physician:
Type of Procedure::

* Diagnostic X-Rays are done on a walk-in basis

** Scheduling department hours are Monday through Friday, from 7 a.m. to 6 p.m

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