Please choose a method below to submit your request. We HIGHLY RECOMMEND using the direct message method so we can route your inquiry to the correct department.

Inquiry

Contact Details

Practice or Law Firm associated with the patient
Number where you can be reached
Contact Name
If a follow up reply is necessary we will use this email address

Inquiry Type

View and burn images & reports to a CD 34x7x365.  

We can no longer burn a CD and mail it to you.  Please watch the quick video above to get access to your patient or client today

Please note we require a signed lien by the attorney before we can send any bills

 

Please enter your information below and we will mail your referral forms within 2 business days.

 

Fax number where we should send your request
Email address where we should send your request

Enter 1 or more Physician or Attorney names you need a login for:

Specific Details (if needed)

Please be as specific as possible so we can assist you in a timely manner
File Type: PDF, Word, Excel, JPG Zip or RAR . Max of 5 files can be uploaded at 10MB each
Please sign above