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

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* 2. What is your complete Mailing Address?

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* 3. How Many Requsition pads do you need?

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* 4. Do you need access to our Physician viewing portal? If so please email Lori: at l.myers@xrayassociates.org

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* 5. Reports directly to your EMR! 80% of you are there now! Email Lori to join @ l.myers@xrayassociates.org

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* 6. Your feedback is important to us. Your comments and feedback help us with our continuous improvement efforts.