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First Name:

Last Name:

Date of Birth: (mm/dd/yyyy)

Telephone Number:

Email:

Home Address:

City:

Province: (Only for Canada)

Country:

Postal Code:

Personal Health Care Number (Care Card):

Area Needed To Scan:

Area Needed To Scan (2nd):

Other:

Preferred Appointment Date:

Preferred Appointment Time:

Please fax (604-734-2469) or email your physician referral to us info@aimmedicalimaging.com.

Or, upload here

We will call you shortly to confirm your appointment.
Thank you for choosing AIM Medical Imaging.

We at AIM Medical Imaging understand that booking services online involves significant trust on your part. We value your trust, and we make it a high priority to ensure the security and confidentiality of the personal information you provide to us. AIM Medical Imaging will not disclose or distribute confidential information to third parties without prior written consent by each patient.

1371 West Broadway
Vancouver, BC, V6H 1G9
info@aimmedicalimaging.com
604.733.4007
1.877.482.5859

Official MRI Centre of
The Vancouver Giants