Skip to content
Request Appointment
Pay Bill
Physician Login (PACS)
Home
Our Specialties
Orthopaedic Imaging
Body Imaging
Neuro Imaging
Women’s Imaging
Our Practice
Meet Dr. Uppal
About Us
Our Management
Our Radiologists
Our Technology
Low-Dose CAT SCAN
3T MRI
Case Studies
Our Logo
Physician Resources
Physician’s Image Portal
Patient Resources
Request an Appointment
Health Companion (Patient Login)
Handouts
Patient Forms
Billing (Login)
Insurance Information
Patient Survey
Reviews
Write a Reveiw
Careers
Contact
Contact Form
Our Centers
Blog
Search for:
Request an Appointment
Request an Appointment
Daisy Uppal, M.D.
2019-02-12T16:51:36-05:00
Request an Appointment
Please use this form to request an appointment with Charter Radiology.
Patient's Name
First
Last
Patient's Date of Birth
MM
DD
YYYY
Patient's Home Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Patient's Phone
Patient's Email
Insurance Provider (Name of Company)
Referring Physician's Name
Type of Imaging
MRI
CAT SCAN (CT)
X-RAY
Preferred Appointment Date
Preferred Appointment Time
:
HH
MM
AM
PM
Preferred Appointment Location
Columbia
Reisterstown
First Available / No Preference
Comments
Phone
This field is for validation purposes and should be left unchanged.
We are now open 7 days a week!
Call
443-917-2855
for an appointment.
CLOSE