Skip to content
Call Us : 443-917-2855
Text Us : 443-878-2175
Request Appointment
Pay Bill
Physician Login (PACS)
Patient Imaging Portal
Specialties
Orthopaedic Imaging
Neuro Imaging
Women’s Imaging
Breast MRI
Women’s Pelvic Imaging
Defecography
Urology Imaging
Prostate MRI
PET/CT for Prostate Cancer
Kidney Stones Dual Energy CT
Cardiac
Calcium Score
Coronary CTA
Cardiac MRI
Full Body Imaging
Computed Tomography Angiography (CTA)
MR Enterography
MR Elastography
Defecography
Lung
Low-Dose CAT SCAN
Pulmonary Nodule Clinic
Diagnostic X-Rays
Our Practice
About Us
Our Logo
Our Team
Meet Dr. Uppal
Case Studies
Blog
Advanced Technology
3T MRI
Low-Dose CAT SCAN
PET/CT
Diagnostic X-Rays
DEXA
Patient Resources
Patient Imaging Portal
Referral Form
Request an Appointment
Patient Forms
Billing (Login)
Insurance
Educational Materials
Reviews
Write a Reveiw
Locations
Clarksville
Columbia
Reisterstown
Contact
COVID-19
Search for:
Specialties
Orthopaedic Imaging
Neuro Imaging
Women’s Imaging
Breast MRI
Women’s Pelvic Imaging
Defecography
Urology Imaging
Prostate MRI
PET/CT for Prostate Cancer
Kidney Stones Dual Energy CT
Cardiac
Calcium Score
Coronary CTA
Cardiac MRI
Full Body Imaging
Computed Tomography Angiography (CTA)
MR Enterography
MR Elastography
Defecography
Lung
Low-Dose CAT SCAN
Pulmonary Nodule Clinic
Diagnostic X-Rays
Our Practice
About Us
Our Logo
Our Team
Meet Dr. Uppal
Case Studies
Blog
Advanced Technology
3T MRI
Low-Dose CAT SCAN
PET/CT
Diagnostic X-Rays
DEXA
Patient Resources
Patient Imaging Portal
Referral Form
Request an Appointment
Patient Forms
Billing (Login)
Insurance
Educational Materials
Reviews
Write a Reveiw
Locations
Clarksville
Columbia
Reisterstown
Contact
COVID-19
Search for:
Request an Appointment
Daisy Uppal, M.D.
2020-09-23T07:15:33-04:00
Request an Appointment
Please use this form to request an appointment with Charter Radiology.
Patient's Name
First
Last
Patient's Date of Birth
Month
Day
Year
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
DEXA
PET CT
Ultrasound
Preferred Appointment Date
MM slash DD slash YYYY
Preferred Appointment Time
:
Hours
Minutes
AM
PM
Preferred Appointment Location
Clarksville
Columbia
Reisterstown
First Available / No Preference
Comments
Phone
This field is for validation purposes and should be left unchanged.
Δ