(Rev. 08/2013)

PET/CT Scheduling 866-245-5995 or 877-689-5713PET/CT Fax 800-508-1064

o South County Hospital Healthcare System

o Our Lady of Fatima Hospitalo Roger Williams Medical Centero Westerly Hospital

o Memorial Hospital of Rhode Island

o Kent Hospitalo Landmark Medical Center

Appointment Date: __________________________ Time: _______________

• Weight over 350 pounds* • Pregnant • Diabetic or elevated blood sugars • Recent radiation therapy

Please call PET/CT scheduling at (866) 245-5995 or (877) 689-5713 if any of these apply to you or if you have any questions. *Factors such as a patient’s body weight, body habitus and scan type may determine whether or not the scan can be performed.

PET/CT Scheduling 866-245-5995 or 877-689-5713

PET/CT Fax 800-508-1064