Request an Appointment

Please use the form below to request an appointment. Once we have received your request we will be in contact with you to arrange a suitable time and location for your examination.

Patient Details

First Name

Last Name

Email

Phone

Upload your Referral Form

Appointment Details

Examination Requested

X-ray
Ultrasound
CT Scan
MRI Scan
Mammogram
Bone Densitometry
Other

Preferred Location

Promed House, Tauranga
Grace Hospital Campus
Mount Maunganui
MRI Tauranga Hospital Campus
Katikati
Te Puke
Whakatane

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