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.
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1.
Name of Physician or Office
(Required.)
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2.
What is your complete Mailing Address?
(Required.)
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3.
How Many Requsition pads do you need?
(Required.)
4.
Do you need access to our Physician viewing portal? If so please email Lori: at l.myers@xrayassociates.org
5.
Reports directly to your EMR! 80% of you are there now! Email Lori to join @ l.myers@xrayassociates.org
6.
Your feedback is important to us. Your comments and feedback help us with our continuous improvement efforts.
Current Progress,
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