London X-Ray Associates - Schedule Appointment

Request an Appointment

NOTE: We are aware of issues with this form and are working on a solution. If you can't submit the form, you can try closing your browser and submitting it in the Microsoft Edge web browser instead. Patients who could not submit this form in Chrome or Firefox have had success in the past with Edge.

COVID-19 SCREENING: If you have traveled outside of Canada, have been exposed to a known case of COVID-19 or are feeling unwell, we ask that you postpone your visit.

Important:

A requisition must be provided by your physician in order to schedule an appointment by phone or when using the 'On-line Scheduling Call-Back Request Form' below. We are not able to pre-book your appointment without it.

Please upload a scan or high quality photo of your requisition using the REQUISITION - UPLOAD field below. Please contact your Physician to request a copy and please ensure that you also bring the copy in on your exam/appointment date.

To schedule an appointment by phone please contact our scheduling team at 519-672-7900 during our business hours of 8:00am to 4:45pm, Monday to Friday.

If you would prefer a call-back from one of our Schedulers to book your appointment please use the form below. One of our scheduling team members will contact you within 48 business hours to book your exam. We are fielding a higher volume of requests. Your patience is appreciated.

Ontario Breast Screening Program (OBSP) - Mammography self referral

Please note that OBSP patients under 75 yrs of age do not need a referral from their physician to book a OBSP Mammogram.

To book an OBSP Mammogram [CLICK HERE]

Although not all fields are required the more details we have the quicker we can book your exam(s).

REQUISITION - Upload a Picture/PDF - THIS IS NOW MANDATORY*

Personal Information

First Name*

Last Name*

Date of Birth (DD-MM-YYYY)*

Weight(lb)*

Health Insurance Coverage

Health Card#*

Version Code

Insurance Details/Comments

Gender*

Required Exams

Due to the high volume of incoming requests, your requested date might not be available. Additionally, not all exam types are performed at each of our locations.

[E.g., BMD exams are only performed at Bradley, while Mammography exams are only performed at Bradley and Central]

Preferred Location Preferred Day Preferred Time Select your Exam(s)* X-ray
Ultrasound
Mammography (non-OBSP)
Bone Mineral Densitometry
Echocardiography
Exam Type (E.g. Chest, Abdomen) History/Clinical Findings (As indicated on Referral)* Referring Physician Name* Referring Physician Location

Contact Info:

Phone*

Email*