Radiology Referrals

The form and information provided below are for use by physicians, their office representatives and other care providers who wish to refer a patient for RADIOLOGY SERVICES at UTMB. Contact information collected via this form is used expressly to serve our referring physicians and their patients.

If you are a physician and wish to refer a patient for other services at UTMB, you may do so online.

Radiology Outpatient Diagnostic Order Form

Instructions: Please click on the link below to access our Radiology Referral Form.  

Access the RADIOLOGY REFERRAL FORM 

You may 1) print a blank copy of the form, fill in and fax; or 2) fill the form online, print and fax. Please remember to sign either option and fax to the number of your specific clinic. A UTMB staff member will follow up with you promptly.  

UTMB Health Specialty Care Center at Victory Lakes

Imaging Center at Victory LakesUTMB Health’s new Specialty Care Center at Victory Lakes boasts state-of-the-art radiology imaging equipment to meet all medical imaging needs. We provide same day services and are conveniently located between Galveston and Houston.

Modalities offered are: HDCT; Dexa; Diagnostic Radiology; Interventional Radiology; Digital Mammography; MRI; Ultrasonography and Nuclear Medicine

If you have questions or need assistance with Radiology referrals to Victory Lakes, please contact Cheryl Johnson.

UTMB Health Radiology Galveston

UTMB Health Radiology Galveston

UTMB Health Radiology located on Galveston Island offers imaging services to accommodate today’s busy lifestyles (including evening and weekend hours).

Modalities offered are: CT; Dexa; Diagnostic Radiology; Interventional Radiology; MRI; Digital Mammography; Nuclear Medicine; Ultrasonography

If you have questions or need assistance with Radiology referrals to UTMB Galveston, please contact Maria Solis.

UTMB Health Radiology Referral Form

    Download Referral Form

 

UTMB Health Specialty Care Center at Victory Lakes
2240 Gulf Freeway South
Suite 1.204
League City, Texas 77573

Phone: (832) 505-1400
Phone: (409) 772-7150
Fax: (281) 309-0259
Fax: (409) 747-2850

UTMB Health Radiology
Galveston
1005 Harborside Dr.
Galveston, TX 77550

Phone: (409) 772-7150
Fax: (409) 747-2850

 

 
 

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