Radiology Clinic Letterhead Order Form

Radiology Clinic:*

Contact Person:*

Phone:*

Email:*

Ship to Address:*

Street Address City Province Postal Code

Choose clinic to receive the order*

Canada Diagnostic Centres - Calgary*

Canada Diagnostic Centres - Edmonton*

Medical Imaging Consultants*

Any change in your clinics address or information?*

If yes, please specify:*

Specify number of Letterhead packages for each clinic selected:*

(Packages of 500)

Specify number of Envelope packages for each clinic selected:*

(Packages of 500)

Additional Information

Please allow 30 business days for order and delivery.

For inquiries call toll free: 1-866-727-3926

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