Request Appointment

Please complete the form below to request an appointment. Certain exams may require patient preparation - please go to http://draxray.com/about-your-exam to see our About Your Exam page for further information.

Name

Date of Birth

Phone

Email

Type of Exam

Please list 3 dates you are available.

Time of Day Requested:





Location Requested:







Enter the numbers from the image:



        
Medical Arts Building, 134 Grandview Ave., Suite 101, Waterbury, CT, 06708, United States
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