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Questions or Comments

Risk Factor Questions

Please answer all the questions below so we can process your appointment request as efficiently as possible. We will contact you to confirm your appointment or request additional information.

What is your birthday?

YesNo

Have you ever had high blood pressure?
YesNo

Have you ever had high blood sugar or diabetes?
YesNo

Do you currently use any tobacco (smoke, chew…)?
YesNo

What is your height? (feet and inches)

What is your current weight? (lbs)

What service would you like to schedule?
Wellness Body ScanHeart ScanCarotid Artery ScanVirtual Angiogram (Currently Unavailable)Lung ScanPelvic ScanVirtual Colonoscopy (Currently Unavailable)I Don't Know

First Date Choice

Second Date Choice

Third Date Choice

How did you hear about us?
EmailRadioYelpWeb Search (Google, Bing…)Customer ReferralPrevious CustomerOther

Disclaimer: Viascan runs promotions on multiple advertising platforms. These incentives are unique to the advertiser (Radio, Yelp, Facebook, etc.). You CANNOT combine the savings. Please pick one discount that best fits your needs, and we are more than happy to honor it.

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