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REQUSITION REQUEST FORM

X-RAY ASSOCIATES

For your convenience, we provide interactive requisitions. If you require any other forms or have any questions please feel free to contact us.
1.Name of Physician or Office(Required.)
2.What is your complete Mailing Address?(Required.)
3.How Many Requsition pads do you need?(Required.)
4.Do you need access to our Physician viewing portal? If so please email PACS Admin: at pacs.admin@xrayassociates.org
5.Reports directly to your EMR! 80% of you are there now! Email PACS Admin to join pacs.admin@xrayassociates.org
6.Your feedback is important to us.  Your comments and feedback help us with our continuous improvement efforts.
Current Progress,
0 of 6 answered