Forms

As a service to our referring providers, here are links to several forms . If you have questions regarding any of these forms, please contact us at 307-634-7711.

Records Release Authorization

Use this form to authorize the release of patient medical records to Cheyenne Radiology.

X-Ray and Fluoroscopy Order Form

Use this form to request and exam from CRG

Ultrasound Order Form

Use this form to request an exam from CRG

MRI Order Form

Use this form to request an exam from CRG

Mammogram Order Form

Use this form to request an exam from CRG

CT Order Form

Use this form to request an exam from CRG