Appointment Request Form

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We’re so glad you’ve chosen Bright Light Medical Imaging for your care! To help us schedule your appointment smoothly, please fill out this form only if you have a provider’s order for an imaging test. (The only exception is for screening mammograms—no order needed for those!)

💡 A Quick Note:
We’ll take care of your request within 1–2 business days.

⏱️ In a Hurry?
If you need your appointment scheduled sooner, just give us a call at 847-616-2000 (or go back to our website and click the Message Us button)—we’re always happy to help.

Thank you for trusting us with your care. We look forward to seeing you soon!
Shine Bright!

Do you have an order from your doctor or provider for this test? *

Yes

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