Scheduling Request for Outpatient Testing or Diagnostic Services
St. Clair is happy to assist you and to ensure clinical services are scheduled correctly based on your physician order. Due to the complexity of scheduling your service, St. Clair is asking for basic information related to your scheduling needs and will phone you at your convenience, based on the information below, to complete and confirm your scheduled visit.
Please complete the following information and then click the “Submit Request” button to complete your request. You will be contacted within 1 business day of submission.
Scheduling Request
Requestor Information
Patient Information
When Can We Contact You?
Requested Service
This request is for:
Please provide a first name.
Please provide a last name.
Please provide a relationship.
Please provide a first name.
Please provide a last name.
Please provide a birth date.
Please provide a phone number.
All return calls placed between 8:30 AM – 4:30 PM. Please select a return call time.
Please provide a return call time.
Please provide a type of visit.
Please provide an ordering physician.
Do you have a prescription / order for services?

Your scheduling request has been submitted.

You will be contacted within 1 business day of submission by a scheduling representative to confirm your request for service.

Please have your insurance information and the doctors prescription/order for the requested service so we can confirm the visit.