Please fill out the following online form. Once we receive your request, we will contact your patient directly within 24 hours to schedule their appointment. Patient Name * D.O.B. Requested time to be seen: 1 to 2 days 3 to 5 days If requested to be seen immediately, please call our office at (319) 383-3606. Body part to be x-rayed Views to be taken Symptoms/Diagnosis Physician's name Physician NPI # Films read by Mercy Radiologist? Yes No Films to be sent back with patient for ordering physician? Yes No CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * 13 + 5 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.