Search Knowledge Base by Keyword

1. Request a Login

You are here:
< Back

Please enter your contact information and we will call you shortly to get you set up to view scheduled patients, reports and images


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

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)

Where should we mail your request?
Suite or Unit Number
Please be as specific as possible so we can assist you in a timely manner
Maximum upload size: 10MB
File Type: PDF, Word, Excel, JPG Zip or RAR . Max of 5 files can be uploaded at 10MB each