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Scheduling Request

Welcome to Mercy Hospital’s On-Line Scheduling Request Portal.

This form may be used by physicians, their office personnel or patients to request an outpatient diagnostic test in lieu of calling our Scheduling Department directly at (305) 285-2761. Our Scheduling staff will contact you within 24 hours (excluding weekends and holidays) to complete your appointment. Please be sure to provide all information requested. Should you have any questions or comments you may contact me at (305) 285-2705.

David Keebler
Director, Patient Access

Note: For patients over 70 having any exam that requires contrast, BUN-Creatinine lab tests must be completed prior to your exam and the results faxed to our Scheduling department at (305) 860-5176.

Physician Information
Name
Phone
Patient Information
Last Name
First Name
Middle Name
Phone
Date of Birth
Procedure